bluuebunny/crossref_metadata_2025 huggingface dataset:
Magnetic Resonance Imaging Parameters at 1 Year Correlate With Clinical Outcomes Up to 17 Years After Autologous Chondrocyte Implantation
Authors: McCarthy Helen S. , McCall Iain W. , Williams John M. , Mennan Claire , Dugard Marit N. , Richardson James B. , Roberts Sally
Published: August 2018

Background:

The ability to predict the long-term success of surgical treatment in orthopaedics is invaluable, particularly in clinical trials. The quality of repair tissue formed 1 year after autologous chondrocyte implantation (ACI) in the knee was analyzed and compared with clinical outcomes over time.

Hypothesis:

Better quality repair tissue and a better appearance on magnetic resonance imaging (MRI) 1 year after ACI lead to improved longer-term clinical outcomes.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Repair tissue quality was assessed using either MRI (11.5 ± 1.4 [n = 91] or 39.2 ± 18.5 [n = 76] months after ACI) or histology (16.3 ± 11.0 months [n = 102] after ACI). MRI scans were scored using the whole-organ magnetic resonance imaging score (WORMS) and the magnetic resonance observation of cartilage repair tissue (MOCART) score, with additional assessments of subchondral bone marrow and cysts. Histology of repair tissue was performed using the Oswestry cartilage score (OsScore) and the International Cartilage Repair Society (ICRS) II score. Clinical outcomes were assessed using the modified Lysholm score preoperatively, at the time of MRI or biopsy, and at a mean 8.4 ± 3.7 years (maximum, 17.8 years) after ACI.

Results:

At 12 months, the total MOCART score and some of its individual parameters correlated significantly with clinical outcomes. The degree of defect fill, overall signal intensity, and surface of repair tissue at 12 months also significantly correlated with longer-term outcomes. The presence of cysts or effusion (WORMS) significantly correlated with clinical outcomes at 12 months, while the presence of synovial cysts/bursae preoperatively or the absence of loose bodies at 12 months correlated significantly with long-term clinical outcomes. Thirty percent of repair tissue biopsies contained hyaline cartilage, 65% contained fibrocartilage, and 5% contained fibrous tissue. Despite no correlation between the histological scores and clinical outcomes at the time of biopsy, a lack of hyaline cartilage or poor basal integration was associated with increased pain; adhesions visible on MRI also correlated with significantly better histological scores.

Conclusion:

These results demonstrate that MRI at 12 months can predict longer-term clinical outcomes after ACI. Further investigation regarding the presence of cysts, effusion, and adhesions and their relationship with histological and clinical outcomes may yield new insights into the mechanisms of cartilage repair and potential sources of pain.
A Review of the Possible Perceptual and Physiological Effects of Wind Turbine Noise
Authors: Carlile Simon , Davy John L. , Hillman David , Burgemeister Kym
Published: August 2018

This review considers the nature of the sound generated by wind turbines focusing on the low-frequency sound (LF) and infrasound (IS) to understand the usefulness of the sound measures where people work and sleep. A second focus concerns the evidence for mechanisms of physiological transduction of LF/IS or the evidence for somatic effects of LF/IS. While the current evidence does not conclusively demonstrate transduction, it does present a strong prima facia case. There are substantial outstanding questions relating to the measurement and propagation of LF and IS and its encoding by the central nervous system relevant to possible perceptual and physiological effects. A range of possible research areas are identified.
Learning about Race: The Lived Experiences of Interracially Married U.S.-born White and European Immigrant Women in the 1930s
Authors: Adeyinka-Skold Sarah , Roberts Dorothy E.
Published: August 2018

How did intermarriage between African Americans and European immigrants influence how European immigrants learned about race in the United States? In this study, the authors compare the lived experiences of European-born and U.S.-born white women married to U.S.-born black men in Chicago in the late 1930s. The authors find that both groups of women characterized their lives as marked by material, social, and institutional costs, and they experienced these costs as racial boundary policing, racial border patrolling, and rebound racism. The authors argue that through these experiences, European immigrant women learned about the racial hierarchy and the importance of whiteness in the United States. The authors also find that European immigrant women had differing reactions to their race learning. Younger European immigrant women strengthened their ties to white racial community, while older European wives strengthened their ties to black racial community. These findings add to immigration literature that explores how immigrants discover the significance of race, racism, and racial hierarchy in the United States and come to understand and respond to the impact of the racial order on their life outcomes.
Excessive work regimes and functional stupidity
Authors: Alvesson Mats , Einola Katja
Published: August 2018

In order to understand why individuals accept and reproduce excessive time regimes, this paper addresses five key drivers: (1) intrinsic motivation, (2) extrinsic motivation, (3) organizational norms, (4) the principle of reciprocity, and (5) identity, including having the ‘true grit’ and belonging to the ‘elite’. It also points to how various elements in excessive work regimes – tendencies towards a closed occupational system, the combination of incentives and ego-boosting and limited time outside work – contribute to functional stupidity, making people disinclined to ask critical questions about work practices and norms, be self-reflective or imagine alternative forms of work organizations, careers or personal objectives.
Investigation of Ga ion implantation-induced damage in single-crystal 6H-SiC
Authors: He Zhongdu , Xu Zongwei , Rommel Mathias , Yao Boteng , Liu Tao , Song Ying , Fang Fengzhou
Published: August 2018

In order to investigate the damage in single-crystal 6H-silicon carbide (SiC) in dependence on ion implantation dose, ion implantation experiments were performed using the focused ion beam technique. Raman spectroscopy and electron backscatter diffraction were used to characterize the 6H-SiC sample before and after ion implantation. Monte Carlo simulations were applied to verify the characterization results. Surface morphology of the implantation area was characterized by the scanning electron microscope (SEM) and atomic force microscope (AFM). The ‘swelling effect’ induced by the low-dose ion implantation of 1014−1015 ions cm−2 was investigated by AFM. The typical Raman bands of single-crystal 6H-SiC were analysed before and after implantation. The study revealed that the thickness of the amorphous damage layer was increased and then became saturated with increasing ion implantation dose. The critical dose threshold (2.81 × 1014−3.26 × 1014 ions cm−2) and saturated dose threshold (˜5.31 × 1016 ions cm−2) for amorphization were determined. Damage formation mechanisms were discussed, and a schematic model was proposed to explain the damage formation.
Commentary on the Contributions of Professor H. Sass, Dr G. Gross and Dr Ch. Mundtet al.on ‘Negative’ and ‘Basic’ Symptoms of Schizophrenia
Authors: Roth Sir Martin
Published: August 2018

These three papers by psychiatrists from the German-speaking world all deal mainly with the nature and aetiological basis of the psychological deficits manifest as ‘negative’ symptoms in schizophrenic illness. There is just an echo of the controversies regarding the validity of subdivision of schizophrenia into ‘positive’ and ‘negative’ forms that have received much attention from British and North American psychiatrists in recent years. (Andreasenet al, 1982; Crow, 1985). It appears to be implicitly assumed that schizophrenia is a unity. The acute psychoses which are diagnosed as schizophrenic in most countries but named ‘psychogenic psychoses’ in Scandinavia and ‘bouffée delirante’ in France and ‘emotion psychoses’ in Switzerland (Labhardt, 1963) are not allowed to complicate matters.
The Scale for the Assessment of Negative Symptoms (SANS): Conceptual and Theoretical Foundations
Authors: Andreasen Nancy C.
Published: August 2018

The Scale for the Assessment of Negative Symptoms (SANS) was the first instrument developed in order to provide for comprehensive assessment of negative symptoms in schizophrenia (Andreasen, 1982, 1983). It consists of five scales that evaluate five different aspects of negative symptoms: alogia, affective blunting, avolition-apathy, anhedonia-asociality, and attentional impairment. Each of these negative symptoms can be rated globally, but in addition detailed observations are made in order to achieve the global rating. It is complemented by a Scale for the Assessment of Positive Symptoms (SAPS), which permits detailed evaluation and global ratings of hallucinations, delusions, positive formal thought disorder and bizarre behaviour (Andreasen, 1984). Taken together, the two scales provide a comprehensive set of rating scales in order to measure the symptoms of schizophrenia and to assess their change over time.
Neural Mechanisms of Negative Symptoms
Authors: Andreasen Nancy C.
Published: August 2018

When Kraepelin originally defined and described dementia praecox, he assumed that it was due to some type of neural mechanism. He hypothesised that abnormalities could occur in a variety of brain regions, including the prefrontal, auditory, and language regions of the cortex. Many members of his department, including Alzheimer and Nissl, were actively involved in the search for the neuropathological lesions that would characterise schizophrenia. Although Kraepelin did not use the term ‘negative symptoms', he describes them comprehensively and states explicitly that he believes the symptoms of schizophrenia can be explained in terms of brain dysfunction:

“If it should be confirmed that the disease attacks by preference the frontal areas of the brain, the central convolutions and central lobes, this distribution would in a certain measure agree with our present views about the site of the psychic mechanisms which are principally injured by the disease. On various grounds, it is easy to believe that the frontal cortex, which is specially well developed in man, stands in closer relation to his higher intellectual abilities, and these are the faculties which in our patients invariably suffer profound loss in contrast to memory and acquired ability.” Kraepelin (1919, p. 219)
Depression, Affect and Negative Symptoms in Schizophrenia
Authors: Lindenmayer J.-P. , Kay Stanley R.
Published: August 2018

The relationship of depression with affect deficit in schizophrenic patients continues to challenge both the clinician and the researcher. Often there is considerable difficulty in differentiating these two affect states in a reliable and valid fashion. On the observational level, depressed affect often appears somewhat restricted, having lost the full range of the euthymic state. On a subjective level, schizophrenic patients often complain of anhedonia, a defect in pleasure capacity which is shared by patients who are depressed. On the prognostic level, there is a large body of literature that links depressive features in acute schizophrenics to favourable subsequent course (Astrup & Noreik, 1966; Vaillant, 1964). We were, therefore, interested in investigating the relationship of depression with impaired affect and with positive/negative symptoms in young acute schizophrenic patients. We used a systematic multidimensional study of affect impairment among 37 young acute schizophrenic patients in a prospective, longitudinal approach over a 2-year span. In addition to a detailed assessment of the affect profile, including depression, both at baseline and on follow-up, we rated patients clinically for a positive and negative syndrome as well as general psychopathology, and we conducted premorbid and outcome measurements.
Psychological and Social Aspects of Negative Symptoms
Authors: Strauss John S. , Rakfeldt Jaak , Harding Courtenay M. , Lieberman Paul
Published: August 2018

Our reintroduction of the concept of negative symptoms in schizophrenia (Strauss et al, 1974) has been followed by much productive research on this topic. As in the work of Andreason, Crowe, and others, the focus of most of this research has been on improving descriptive assessments of these symptoms (Andreason, 1982) and exploring their biological correlates (Crowe, 1981). This work has been extremely important, but psychological and social aspects of negative symptoms are also important (Barton, 1959; Wing & Brown, 1970; Gruenberg, 1967), and in these areas there has been little research. Nevertheless, it is crucial to explore possible psychological and social factors in negative symptoms in order to understand the symptoms more fully and to provide a basis for more adequate prevention and treatment. It is also important to clarify psychological and social factors in these symptoms to provide a basis for more effective biological research, since the heterogeneity of negative symptoms at a psychological level could hide significant biological correlates.
Serotonergic Dysfunction in Depression
Authors: Meltzer Herbert
Published: August 2018

Various irregularities in serotonin (5-HT) function have been postulated as causes of affective disorders. Serotonin has been related to many of the major symptoms of depression, e.g. mood, appetite, sleep, activity, and cognitive dysfunction. Interference with 5-HT synthesis or storage has been shown to induce depression in vulnerable individuals. Decreased levels of 5-hydroxyindoleacetic acid (5-HIAA) in cerebrospinal fluid, decreased plasma tryptophan, low tryptophan neutral amino acid ratio, abnormalities in serotonergic function indicated by neuroendocrine challenge tests and various platelet measures, have been reported in depressed patients. Concentrations of 5-HIAA, the major metabolite of 5-HT in plasma, were found to be significantly negatively correlated with severity of depression as measured by the Hamilton Rating Scale for Depression score and specific depressive symptoms, despite the fact that plasma 5-HIAA is largely peripheral in origin. Blood platelets, which have been suggested as models for serotonergic nerve terminals, have a significantly decreased number of 5-HT uptake sites and 3H-imipramine binding sites in depressed patients. Antidepressant drugs may act, in part, by enhancing serotonergic activity. The serotonergic deficit may occur at any of several levels: diminished availability of precursor, impaired activity of tryptophan hydroxylase, abnormalities in 5-HT release or uptake, 5-HT receptor abnormalities or interactions with other neurotransmitters.
Psychiatry and the New Magnetic Resonance Era
Authors: Lock T. , Abou-Saleh Mohammed T. , Edwards Richard H. T.
Published: August 2018

Psychiatry's lack of understanding of the pathogenesis of mental disorders has resulted in the attempt, within the antipsychiatry movement, to persuade the world that mental disorder does not exist (Szasz, 1961). Progress towards understanding the underlying biological bases of psychiatric syndromes has been impeded by two factors: (a) a most effective physical barrier – the skull; and (b) dichotomous thinking of structure on the one hand and function on the other.
Sexual Abuse, Disordered Personality and Eating Disorders
Authors: McClelland Lisa , Mynors-Wallis Lawrence , Fahy Tom , Treasure Jane
Published: August 2018

Standardised personality assessments were administered to 50 consecutive referrals to an Eating Disorders Clinic. A history of childhood sexual abuse was identified in 30% of patients using a modified version of the SLEI. This rate is comparable with those from other studies. Overall, 52% of the patients were rated as having a personality disorder but a significantly higher proportion of women with a personality disorder had a history of childhood sexual abuse compared with those without a personality disorder (13/26 v. 2/24, FisherP< 0.001). Although in patients with eating disorders no clear causal link between CSA and personality disorder was demonstrated, our findings emphasise the need to inquire sensitively into the sexual history of such patients.
Where do People with Long-Term Mental Health Problems Live?
Authors: Conning Alison M. , Rowland Len A.
Published: August 2018

The closure of large psychiatric institutions has led to alternative accommodation being developed for people with long-term psychiatric disabilities, with an emphasis on group living. Despite this, very little is known about where these people live, about the accommodation needs of this group, or whether men and women have differing needs. This paper examines the accommodation of all people with long-term and severe psychiatric disabilities in one South London borough who were in contact with a specialist service. It was found that the majority of people either live with their families – although the family member differed for men and women – or live alone. Men were more likely than women to live in hostels or alone, while women were more likely than men to live with their families.
The TAPS Project. 8: Design of the Research Study on the Long-Stay Patients
Authors: O'Driscoll Catherine , Leff Julian
Published: August 2018

This paper describes the origins of the TAPS project and the design of the prospective study of the long-stay patient populations of Friern and Claybury hospitals, two large mental hospitals in north-east London scheduled for reprovision and closure by the regional health authority.
The Person with Schizophrenia as a Person
Authors: Strauss John S.
Published: August 2018

In the mental health field, the attention given to the subjective side of a person's experience is grossly inadequate. The best way to reflect the subjectivity of a person may be by means of the subjectivity of another. To take account of both subjective experience and objective measures in the course of mental disorders, a new concept is needed. This may be the person's story.
A Behavioural Training Programme for Chronic Schizophrenic Patients
Authors: Li Feifei , Wang Mingde
Published: August 2018

This paper discusses the effectiveness of an in-patient rehabilitation programme administered by nurses that combines life skills training, active encouragement, and a token economy. Fifty-two chronic schizophrenic patients with prominent negative symptoms who had been continuously in hospital for at least a year were randomly assigned to the experimental or control group. The training and associated reinforcement schedule were administered daily to experimental subjects by two specially trained rehabilitation nurses. Control subjects did not receive training or reinforcement but were individually asked to perform the same daily tasks and participate in the same activities as the experimental-group subjects. Patients in both groups received their previous dosage of medication throughout the trial. After three months the severity of negative symptoms, as assessed by blind evaluators, decreased in both groups of subjects, but the improvement in the experimental group was much greater than that in the control group. These findings demonstrate the efficacy of behavioural interventions for chronic schizophrenic in-patients in China and highlight the importance of changing the role of Chinese psychiatric nurses from that of custodians who control patients' behaviour to that of therapists who provide psychological and behavioural treatment.
Community-Based Psychiatric Rehabilitation in Shanghai
Authors: Zhang Mingyuan , Yan Heqin , Phillips Michael R.
Published: August 2018

This paper describes the community mental health services in Shanghai, analyses the effectiveness of these services, and discusses their culture-specific characteristics. It reports on a prospective, matched-control study of the three most important types of service: a community follow-up programme in psychiatric out-patient clinics at primary-level general hospitals, ‘guardianship networks’ operated by non-professional volunteers, and work therapy stations. In total 308 pairs of subjects completed the study. Using Chinese versions of the Disability Assessment Schedule to assess impairment in psychosocial functioning and the Present State Examination to assess the levels of positive and negative symptoms, ten blind evaluators who had excellent inter-rater reliability assessed the functioning of subjects at enrolment and every six months for the next two years. Over the two years, symptoms and social functioning improved in the treatment groups and deteriorated in the control groups. Thus these community psychiatric services have the dual benefit of promoting rehabilitation and preventing psychosocial deterioration.
The Role of Human Rights and Personal Dignity in the Rehabilitation of Chronic Psychiatric Patients
Authors: Jin Dongxi , Li Guishu
Published: August 2018

In 1983 the branch hospital of the Yanbian Community Psychiatric Hospital, a rural residential centre for 120 chronic psychiatric patients who have no means of financial support, adopted a new treatment philosophy that emphasised psychosocial rehabilitation and made the protection of patients' human rights and respect for their personal dignity the central organising principles for the hospital's treatment programme. From being a boarding facility for chronic psychiatric patients, the hospital became a thriving community. Comparison of the status of the 81 continuously resident schizophrenic patients before and after the policy change showed that (a) the proportion who actively participated in agricultural labour increased from 10% in 1982 to 38% in 1990; (b) the proportion who worked at non-agricultural jobs increased from 7% in 1982 to 22% in 1990; and (c) their mean yearly income increased from 1.67 Rmb in 1982 to 246.70 Rmb in 1990. Moreover, the number of successful suicides among all the patients in the hospital dropped from 13 in 1975–1982 to 1 in 1983–1990. We conclude that the success of psychiatric rehabilitation programmes depends on the extent to which they address the core issues of personal dignity and basic human rights.
Economics and Schizophrenia: The Real Cost
Authors: Davies Linda M. , Drummond Michael F.
Published: August 2018

The total direct cost of treating schizophrenia in the UK is £397 million, or 1.6% of the total health care budget. Hospital-based and community-based residential care accounts for nearly three-quarters of these costs, while drugs account for only 5%. A conservative estimate of the indirect annual costs of lost production is in the region of £1.7 billion. The heterogeneity of the disease and its outcome means that average treatment costs per person with schizophrenia should be treated with caution; 97% of direct costs are incurred by less than half the patients. Therefore, treatments which reduce the dependence and disability of those most severely affected by schizophrenia are likely to have a large effect on the total cost of the disease to society and may therefore be cost-effective, even though they appear expensive initially.
Long-Term Treatment of Depression
Authors: Montgomery Stuart A.
Published: August 2018

Long-term treatment of depression encompasses two separate phases: relapse and recurrence prevention. Relapse prevention aims to consolidate the response to acute treatment. Some tricyclic antidepressants (TCAs) have been shown to be effective, possibly in lower than standard acute treatment doses. The selective serotonin reuptake inhibitors (SSRIs) have been shown to be effective at the same minimum effective doses used to treat acute depression, or in a lower dose as with citalopram. Recurrence prevention aims to reduce the risk of onset of a new episode of depression in patients with recurrent depression. Imipramine has been thoroughly studied in unipolar depressed patients in full therapeutic doses for up to five years and is clearly effective. Other TCAs have not been adequately tested and may not all be equally effective. The SSRIs fluoxetine, paroxetine and sertraline have also been shown to be effective in reducing the risk of new episodes of depression.
Glutamatergic aspects of schizophrenia
Authors: Tamminga Carol
Published: August 2018

Almost all the neurons in the brain are influenced by the excitatory amino acid glutamate. Glutamatergic neurotransmission has been associated functionally with a number of physiological processes and with certain pathophysiological processes, including schizophrenia. Imaging studies provide indirect evidence that glutamate may be involved in schizophrenia. Positron emission tomography scanning has shown a correlation between positive symptoms of schizophrenia and abnormalities of glucose metabolism in components of the limbic system with the highest concentration of glutamate receptors. Studies with ketamine, an anaesthetic that antagonises the N-methyl-D-aspartate (NMDA) glutamate receptor, show an exacerbation or worsening of positive symptoms when this drug is administered to patients with schizophrenia. Regional cerebral blood flow studies with ketamine show that the drug produces increased blood flow in the anterior cingulate cortex, the area where high concentrations of NMDA receptors exist and where alterations in glucose metabolism seem to occur in people with schizophrenia. Diminished glutamatergic neurotransmission in the hippocampal gluatamate-mediated efferent pathways and cerebral dysfunction in the hippocampus and its target areas, particularly the anterior cingulate cortex, may underlie some of the clinical manifestations of schizophrenia.
An Empirical Prototypical Approach to the Definition of Psychiatric Illness
Authors: Mezzich Juan E.
Published: August 2018

The facts that neither the International Classification of Diseases (ICD) nor any other major standard diagnostic system have offered a full definition of psychiatric illness and that earnest definitional attempts reported in the literature (e.g. Spitzer & Endicott, 1978) have not received wide acceptance, have led distinguished nosologists (e.g. Kendell, 1985) to suggest that all we can say about psychiatric classifications is that they are classifications of kinds of problems which psychiatrists currently deal with. However, one immediate difficulty with this characterisation is that it is based on what psychiatrists do, when in fact psychiatric problems are dealt with also by other professionals of various types and levels of training. Another difficulty is that it implies that there is not even an approximate common denominator or core concept underlying the various forms of psychiatric disorder listed in the ICD or other standard diagnostic systems.
Anxiety Disorders: Similarities and Differences of Comorbidity in Treated and Untreated Groups
Authors: Wittchen Hans-Ulrich , Essau Cecilia Ahmoi , Krieg Jürgen-Christian
Published: August 2018

The similarities and differences of comorbidity in treated and untreated samples with anxiety disorders were examined using data from the Munich Follow-up Study: 133 subjects with anxiety and depressive disorders and 101 former in-patients at the Max Planck Institute for Psychiatry. Diagnoses were based on the DIS, not using the optional DSM—III exclusion rules. In these epidemiological and clinical samples, 69% and 95% respectively had at least two diagnoses. The epidemiological sample was clearly differentiated from the clinical sample by age of onset. The development of both depressive episodes and substance disorders in the two samples was mostly secondary to the development of anxiety problems. The outcome for subjects with both anxiety and depressive disorders tended to be worse than that for those with anxiety alone, regardless of whether a depressive episode was present at the time of the follow-up investigation. The usefulness is underlined of the comorbidity concept based on operationalised diagnosis without the exclusion rules offered by DSM—III and DSM—III—R.
Buspirone: A Worldwide Update
Authors: Napoliello M. J. , Domantay A. G.
Published: August 2018

Buspirone is an anxiolytic drug from the azapirone family of molecules. It differs chemically and pharmacologically from the benzodiazepines. Although its profile of efficacy is comparable with that of benzodiazepines, it produces less drowsiness, less psychomotor impairment, less alcohol potentiation, and has less potential for addiction or abuse. Buspirone also appears to have efficacy in major depressive disorders, in comparison with placebo, but its activity in panic disorders is less impressive. It may diminish alcohol dependence both in animals and in chronic alcoholics. Clinical studies in the elderly show no important difference from younger patients in safety and efficacy profile, pharmacokinetics, and dosage requirement. The drug appears to be well tolerated in primary care settings and to be free of adverse clinical interactions with many drugs that might be used concomitantly. However, because its pharmacology differs from that of conventional anxiolytics, patients need to be informed about both its gradual onset of action and absence of euphoria and immediate sedation.
Memory, Knowledge and Delusions
Authors: McKenna P. J.
Published: August 2018

In schizophrenia, where they find their fullest expression, delusions are an extraordinary phenomenon. They can take a bewildering variety of forms, persecutory, grandiose, hypochondriacal, referential, and so on. They can be fixed and immutable, or alternatively may shift and change to the point of what Bleuler termed a delusional chaos. Finally, their degree of implausibility starts from the inherently unlikely, ranges through the patently absurd and bizarre, and not infrequently comes to violate common sense at its most elementary in fantastic delusions.
Delusional Perception
Authors: Mellor C. S.
Published: August 2018

This paper reviews the phenomenology of delusional perception and discusses its differentiation from similar phenomena, its diagnostic value, and its pathogenesis. The study of delusional perception is of particular interest, because, unlike other delusions, its identification rests on form as well as content. Also, it is one of the first-rank symptoms of schizophrenia, and its mode of onset, which is an important part of the phenomenon, may help us to understand how other delusions develop.
Neuroendocrine Mechanisms and the Precipitation of Depression by Life Events
Authors: Checkley Stuart
Published: August 2018

It is now generally accepted that stressful life events and chronic difficulties can trigger the onset of depression in predisposed individuals. However, although much is known of the neurobiology of stress, few attempts have been made to provide a biological explanation for the mechanisms whereby life events might trigger depression. Enough is now known of the central control of hypothalamic pituitary adrenal (HPA) function and its response to stress to permit an examination of its role in the neurobiology of the triggering of depression by stress. This evidence is reviewed, and the proposal explored that stress triggers depression by a genomic action of corticosteroids.
Efficacy of Tianeptine in Comparative Trials versus Reference Antidepressants An Overview
Authors: Guelfi J. D.
Published: August 2018

The clinical properties of tianeptine have been assessed in double-blind controlled studies, which involved depressed patients fulfilling DSM-III criteria for either major depression — single episode or recurrent (without melancholia and psychotic features) — or dysthymic disorder —with or without an additional diagnosis of alcohol abuse or dependence. Five studies have compared tianeptine with reference antidepressants: its efficacy has been found to be similar to that of amitriptyline in depressed out-patients. However, these data need to be confirmed by other controlled trials v. reference drugs and by at least two placebo-controlled studies. Tianeptine does not induce sleep disorders, anticholinergic effects, or modifications of cardiovascular variables or biological parameters (renal, haematological, or hepatic). After the end of treatment, the only signs of withdrawal have been some disturbances of sleep.
The Involvement of Serotonin in Psychiatric Disorders and Behaviour
Authors: López-Ibor Juan J.
Published: August 2018

There is evidence that serotonin (5-HT) is involved both in a wide range of psychiatric conditions and in specific behaviours which, in themselves, cannot be considered pathological. Besides the affective disorders (both depressive and manic, and both in full-blown episodes and during the intervals between these, which are seen as vulnerability to relapse) several other conditions need to be considered (Table I). There are also claims that serotonin metabolites or structurally related substances are involved, in their role as false neurotransmitters, in delusions and psychedelic phenomena, as in the case of LSD (Mantegazzini, 1960) or 5-hydroxytryptolines in delusions related to alcoholism (Daviset al, 1967).

This wide range of conditions raises the questions of how specific is the involvement of serotonin, and of what artifacts are present in attempts to investigate its actions. Page, who isolated 5-HT in 1948, stated (1968) that “serotonin has many functions but few have been sharply defined. The great variety of suggested roles can be said to be a tribute to man's ingenuity and his unquestionable willingness to write papers”. Since then, many more roles have been proposed for the involvement of 5-HT in functions of the central nervous system. Nevertheless, good evidence does exist that serotonin has some specific relationships to psychiatric disorders which are worth pursuing, in spite of great methodological difficulties.
Fluoxetine, a Highly Selective Serotonin Reuptake Inhibitor: A Review of Preclinical Studies
Authors: Schmidt Michael J. , Fuller Ray W. , Wong David T.
Published: August 2018

The chemical structure of fluoxetine, (±)-N-methyl-3-phenyl-3-[(α,α,α-trifluoro-p-tolyl)oxy]propylamine, as shown in Fig. 1, lacks the three-fused ring system contained in tricyclic antidepressant drugs (TCAs) such as imipramine and amitriptyline. The p-trifluoromethyl substituent on the phenoxy ring of fluoxetine is an important determinant of its potency and its specificity as a serotonin-uptake inhibitor, e.g. the analogue having an o-trifluoromethyl substituent on that ring is only about one-hundredth as potent as fluoxetine in inhibiting serotonin uptake (Wong et al, 1975a). Nisoxetine (Wong et al, 1975b) and tomoxetine (Wong et al, 1982) are analogues differing from fluoxetine only in having an o-methoxy or an o-methyl substituent respectively, in place of the p-trifluoromethyl substituent on the phenoxy ring. Nisoxetine (LY94939) and tomoxetine (LY 139603) are potent and highly selective inhibitors of norepinephrine uptake (Wong et al, 1975b, 1982), differing strikingly from fluoxetine in specificity of uptake inhibition.

Fluoxetine has been shown to be a potent and selective inhibitor of serotonin uptake in laboratory animals; it is orally effective and has a long duration of action. This compound has been a valuable pharmacological tool to study the mechanisms of serotonergic neurotransmission and physiological functions of brain serotonin neurons (Fuller & Wong, 1977; Wong et al, 1985a; Fuller & Wong, 1987). The present paper summarises some of the pre-clinical studies which have characterised fluoxetine as a selective inhibitor of serotonin uptake.
Depression in people with first-episode schizophrenia
Authors: Addington Donald , Addington Jean , Patten Scott
Published: August 2018

Background Depression has been described in people presenting with first-episode schizophrenia, a group at high relative risk of suicide.

Method This was a longitudinal cohort study of 113 people during an acute relapse and 13 having a first episode. Follow-up occurred at three months and at one year. This report compares level of depression in the first episode and in the relapsing group. Levels of depression were assessed using the Calgary Depression Scale for Schizophrenia (CDSS).

Results The median CDSS score was statistically significantly higher in the first-episode group both during the acute phase and at three month follow-up. At one year the first-episode group continued to have higher levels of depression than the multiple episode group.

Conclusions For people with a first episode of schizophrenia, depression is a major problem during the initial acute phase and during the first year of illness. In light of the high risk of suicide in this population, recognition and treatment of depression requires greater attention.
Group programmes for recovery from early psychosis
Authors: Albiston Dianne J. , Francey Shona M. , Harrigan Susan M.
Published: August 2018

BackgroundWe evaluate the impact of a group-based, transitional, psychosocial programme, within a comprehensive service (the Early Psychosis Prevention and Intervention Centre, EPPIC), on recovery from first-episode psychosis.

MethodIndividuals using the service (and meeting study criteria) were assessed on a range of symptom and functioning instruments at entry, after 6 weeks and 6 months. Participants received comprehensive case management and services according to their identified needs. Thirty-four people who had attended the group programme were compared at 6 month follow-up with 61 EPPIC patients who had not attended.

ResultsThe people attending the group programme had a lower level of premorbid adjustment than the comparison group, and a trend towards exhibiting a higher level of negative symptoms, prior to commencing the group programme. However, at 6 month follow-up, no significant differences were found between the groups.

ConclusionsInvolvement in the group programme may have had a positive impact on a subgroup of EPPIC subjects with poor level of premorbid adjustment, by providing a ‘holding pattern’ in the critical period following the emergence of first-onset psychosis, and thus prevented deterioration and the development of disability.
Role of serotonin in obsessive-compulsive disorder
Authors: Baumgarten H. G. , Grozdanovic Z.
Published: August 2018

Background Serotonin may play a role in the pathophysiology of obsessive-compulsive disorder (OCD) because of the anti-obsessional effect of selective serotonin reuptake inhibitors (SSRJs).

Method The literature is reviewed on knowledge of the role of serotonergic neurons in brain function, studies on monoamine metabolites in cerebrospinal fluid (CSF), various stress neuropeptides, neuroendocrine and behavioural challenge after administration of direct and indirect serotomimetic compounds, and neuroanatomical data on brain circuits organising behaviour.

Results In most of the OCD cases analysed, CSF 5-hydroxyindoleacetic acid and homovanillic acid concentrations do not significantly differ from age-corrected controls. However, a relationship appears to exist between pre-treatment levels of these metabolites and clinical response to drugs acting on the serotonin transporter. Abnormalities in CSF arginine vasopressin, corticotropin-releasing hormone, oxytocin and somatostatin levels have been reported in OCD. Long-term treatment with high-doses of clomipramine, fluvoxamine, and fluoxetine tend to correct these neuropeptide abnormalities.

Conclusions We hypothesise that continuous treatment with SSRJs alters serotonin turnover and neuropeptide expression patterns in OCD-entertaining functional forebrain/midbrain circuits.
Out–patient, multimodal behaviour therapy for obsessive–compulsive disorder
Authors: Hand Iver
Published: August 2018

BackgroundWith regard to long-term outcome, behaviour therapy is the first choice treatment for obsessive–compulsive disorder (OCD), with or without concomitant selective serotonin reuptake inhibitor (SSRI) medication. Yet, results from research trials, usually restricted to exposure with response-preventions and other symptom-directed techniques, may not be generalisable to people with OCD in community health care services.

MethodFor more than 20 years we have delivered out-patient behaviour therapy to unselected people with OCD from the community, including those with motivational and compliance problems. Prospective–retrospective follow-ups were carried out from 1–13 years after treatment.

ResultsThis paper describes the applied multimodal, strategic-systemic behaviour therapy, and our partially new model of OCD. Compliant patients achieved the usual success rate of 65–70%, but this drops to 50% if all patients treated are included in the analysis.

ConclusionsFor major subgroups of OCD, behaviour therapy is a very effective treatment modality. Exposure is essential, but additional (‘causal’) interventions are equally important in about half of the patients from unselected samples. Both behaviour therapy and drug-treatments need to be improved and predictive variables for outcome of either of them are urgently needed.
Neurosurgical treatment of obsessive-compulsive disorder
Authors: Jenike M. A.
Published: August 2018

BackgroundCase reports suggest that neurosurgical operations can improve symptoms in patients with severe treatment-refractory obsessive-compulsive disorder (OCD). However, it is unclear which procedure is best and which may produce the most side-effects.

MethodI review the literature on the efficacy and complications of four frequently used neurosurgical procedures (cingulotomy, capsulotomy, limbic leucotomy and subcaudate tractotomy) that are used to treat refractory OCD.

ResultsSince the vast majority of patients who underwent surgery were severely and chronically disabled, it is likely that these procedures were of assistance in alleviating some of their symptoms. It is currently impossible to determine which surgical procedure is the best for a particular patient.

ConclusionsDespite a lack of controlled data and inconsistencies in the literature, it appears that when nonsurgical treatments have failed to improve OCD symptoms significantly in severely ill patients, at least partial relief can be obtained by some people with OCD by neurosurgery Results of cumulative studies strongly support the need for continued research in this area.
The Leros PIKPA Asylum. Deinstitutionalisation and Rehabilitation Project
Authors: Tsiantis J. , Perakis A. , Kordoutis P. , Kolaitis G. , Zacharias V.
Published: August 2018

A three-year deinstitutionalisation and rehabilitation pilot intervention project was implemented at Leros PIKPA for people with severe learning disabilities. Initial conditions at the asylum were appalling. Residents suffered severe deprivation, extreme institutionalisation, and violation of basic human rights. Intervention involved professionals from different disciplines, and involved residents, their families, care staff, the institution, and the local community. As a result, resident care and adaptive behaviour has started to improve. Communication between residents and families has increased. Owing to training and sensitisation, care staff's poor resident-management practices and negative attitudes toward disabled people have changed. Living and hygienic conditions have been upgraded and building renovation is under way. Asylum administration and the local community have been sensitised to residents' needs. Eleven residents have moved to the project's pilot community home in Athens; two others now live with foster families. The results suggest that deinstitutionalisation and rehabilitation can be successfully initiated even in residential institutions of the severest kind.
Comorbidity (Psycho) Analysed
Authors: Van Praag H. M.
Published: August 2018

Many psychiatric patients seem to suffer from a multitude of psychiatric disorders. The term comorbidity' was introduced to characterise that situation. This term, however, is multi-interpretable and thus conceals more than it clarifies. Five interpretations of the concept of comorbidity are discussed, in conjunction with the consequences their validity would have for psychiatric research, in particular for the biological branch. If the term comorbidity continues to be used without further qualification, it will slow down the process of conceptualisation of novel research strategies in experimental psychiatry, which is so urgently needed.
Patients as parents: the risk to children
Authors: Oates Margaret
Published: August 2018

Traditionally adult psychiatrists have been more concerned with their patient's family of origin than with the family of procreation. When considering the management of the seriously mentally ill, the family is regarded as a potential source of stress or care, and little attention is given to the role of the patient as a parent (Rutter, 1966; Bennett, 1996). This position is exemplified by the absence of questions relating to childcare on the Health of the Nation Outcome Scale (HoNOS; Wing et al, 1995). This scale is likely to be widely used in the Care Programme Approach in England and Wales as an indicator of illness severity and outcome. Such questions should include the effect of the illness and disability on the physical and emotional development of the child, and the patients' ability to manage the responsibilities of childcare.
Establishing Cancer Treatment Programs in Resource-Limited Settings: Lessons Learned From Guatemala, Rwanda, and Vietnam
Authors: Wagner Claire M. , Antillón Federico , Uwinkindi François , Thuan Tran Van , Luna-Fineman Sandra , Anh Pham Tuan , Huong Tran Thanh , Valverde Patricia , Eagan Arielle , Binh Pham Van , Quang Tien Nguyen , Johnson Sonali , Binagwaho Agnes , Torode Julie
Published: August 2018

Purpose

The global burden of cancer is slated to reach 21.4 million new cases in 2030 alone, and the majority of those cases occur in under-resourced settings. Formidable changes to health care delivery systems must occur to meet this demand. Although significant policy advances have been made and documented at the international level, less is known about the efforts to create national systems to combat cancer in such settings.

Methods

With case reports and data from authors who are clinicians and policymakers in three financially constrained countries in different regions of the world—Guatemala, Rwanda, and Vietnam, we examined cancer care programs to identify principles that lead to robust care delivery platforms as well as challenges faced in each setting.

Results

The findings demonstrate that successful programs derive from equitably constructed and durable interventions focused on advancement of local clinical capacity and the prioritization of geographic and financial accessibility. In addition, a committed local response to the increasing cancer burden facilitates engagement of partners who become vital catalysts for launching treatment cascades. Also, clinical education in each setting was buttressed by international expertise, which aided both professional development and retention of staff.

Conclusion

All three countries demonstrate that excellent cancer care can and should be provided to all, including those who are impoverished or marginalized, without acceptance of a double standard. In this article, we call on governments and program leaders to report on successes and challenges in their own settings to allow for informed progression toward the 2025 global policy goals.
Ultrasound-Guided Midpoint Transverse Process to Pleura Block in Breast Cancer Surgery: A Case Report
Authors: Bhoi Debesh , Narasimhan Purnima , Nethaji Ranjitha , Talawar Praveen
Published: August 2018

To avoid the safety issues related to thoracic paravertebral blocks, we performed midpoint transverse process to pleura blocks in 3 patients before general anesthesia for modified radical mastectomies. The midpoint transverse process to pleura blocks served as the major component of multimodal analgesia. With ultrasound guidance, 7 mL of a mixture of 0.75% ropivacaine and 2% lidocaine with epinephrine were deposited at T2, T4, and T6 levels. We noted decreased sensation to cold and pinprick from T2 to T8 dermatome level with sparing of axilla and infraclavicular areas. The maximum pain numeric rating scale score (0–10) was 4 out on movement and none had mean 24-hour numeric rating scale >3.