bluuebunny/crossref_metadata_2025 huggingface dataset:
Wound healing of true vocal cord squamous epithelium after CO2 laser ablation and cup forceps stripping
Authors: Durkin Gretchen E. , Duncavage James A. , Toohill Robert J. , Tieu Thu Minh , Caya James G.
Published: January 2017

A study was conducted on the effect of deepithelization of the true vocal cords; microcup forceps were used, as opposed to CO2 laser ablation. A CO2 laser, coupled to an operating microscope, was used to ablate the surface epithelium of the right true vocal cords in eight canines, while conventional microlaryngeal stripping was performed on the left true cords in the same animals. Photographs were taken immediately after injury and again before the animals were killed. Histologically, the series of true vocal cords ablated by the CO2 laser revealed granulation formation at day 5, whereas those treated with conventional stripping developed granulation at day 3, thus indicating delayed healing. Charred carbonaceous debris of CO2 laser ablation was found to cause a giant cell reaction that persisted after reepithelization. Despite the precise control offered by the laser, many of the laser‐injured true vocal cords revealed vocalis muscle edema and muscle destruction. After healing occurred, dense fibrosis was found in the vocal muscle injured during CO2 laser ablation of the overlying squamous epithelium.
The versatile melolabial flap
Authors: Younger R. A. L.
Published: January 2017

The melolabial flap Is a versatile technique for reconstruction of defects of the central face. Variations of this flap may be used to reconstruct the lower eyelids, the nose, the upper and lower lip, chin, and malar regions. Regional anatomy, Indications, technical considerations, and avoidance of complications are discussed on the basis of 10 bilateral cadaver dissections of the melolabial area, In conjunction with 70 reconstructive cases that used this flap. Statistical analysis of the results reveals that flap viability is compromised by previous radiation and smoking. Consequently, alternate methods of reconstruction of the central face should be used in patients who have a history of these problems.
Overview: The allergic reaction and site‐based therapy
Authors: Mabry Richard L.
Published: January 2017

The successful management of upper respiratory tract allergy is based on a triad of interdependent approaches that, with rare exceptions, must all be considered in every allergic patient. They consist of allergen avoidance with environmental control measures, pharmacotherapy with use of a step‐care approach, and immunotherapy. Environmental control measures should be used to prevent events that trigger and sustain the condition. Once started, the allergic reaction includes the release of mediators of inflammation that produce well‐known symptoms of allergic rhinitis. Treatment should consist of a step‐wise, rational approach that includes site‐based therapy with one or more drugs acting at different sites. The drugs used are antihistamines, decongestants, cromolyn sodium, and corticosteroids. Immunotherapy should be considered at any step, because it offers the only curative approach.
Free from Obedience: Constitutional Expressions of the Right of Resistance in Early Modern Transylvania and Poland-Lithuania
Authors: Roșu Felicia
Published: January 2017

With its tradition of elected kings and rebellious nobility, Poland-Lithuania has acquired a certain amount of fame that extends beyond its own region. To anybody who has heard of the Polish-Lithuanian political system, it would probably come as no surprise that the Commonwealth’s laws included the right to disobey a king who broke the promises he had made at his election. This version of the right of resistance was introduced in Poland-Lithuania’s laws in 1573, and, with very few modifications, it was confirmed by all of Poland-Lithuania’s subsequent monarchs and remained valid until the late eighteenth century, when the country disappeared off the map of Europe. In contrast to that of Poland-Lithuania, Transylvania’s history is much more obscure to outsiders, even though it too included elected rulers, enthronement conditions and the right of resistance. The latter was introduced into Transylvania’s constitutions later than in Poland-Lithuania; its first explicit mention dates from 1613. Its lineage, however, can be traced back to one of Europe’s earliest known versions of a resistance clause: the Hungarian Golden Bull of 1222. While the Polish-Lithuanian formulation was milder, more passive and less specific than some of the Transylvanian versions, its practical application was more effective than it ever became in Transylvania. This article discusses the development and variations of the right of resistance in early modern Polish-Lithuanian and Transylvanian constitutions and it offers some reflections on the complex relationship between constitutional theory and political practices. The Transylvanian case is analysed in more detail because it is relatively less well known.
Revolt from the Right: Russia’s Right-Wing Students Between Conservatism and Radicalism
Authors: Gilbert George
Published: January 2017

The article examines the Academist movement between 1900 and 1914 – the student branches of a number of right-wing groups that emerged in the Russian Empire between 1900 and 1905 and endured throughout the late imperial period. It will argue that these groups arose separately from the Russian autocracy, and formed part of an independent, ‘right-wing’ approach to the problems facing Russian society in the late imperial period. It is particularly concerned with the idea, widely present on the right, that the Russian present was in a period of crisis and a more drastic approach to moral and spiritual renewal was needed. It will consider the nature of the Academists’ conceptions of moral education, spiritual renewal of society, and also their violence, anti-Semitism and emergence of an ethno-populist politics. The contention is that the emergence of an independent right-wing movement contributed to the wider instability in the Russian autocracy in the late imperial period.
Use of aprotinin in repeat myocardial revascularization: Cleveland Clinic experience
Authors: Cosgrove Delos M
Published: January 2017

Preliminary findings of a prospective, randomized, double-blind study of aprotinin in patients undergoing repeat myocardial revascularization procedures are presented. Use of high- or low-dose aprotinin led to signfiicant (p < 0.001) reductions in postoperative chest tube drainage compared with placebo (720 ± 753 ml, 866 ± 1636 ml, and 1121 ± 683 ml, respectively). Aprotinin also yielded significant reductions in transfusion requirements (2.1 ± 4.2 units, 4.8 ± 11.8 units, and 4.1 ± 6.2 units). These reductions were similar in a subgroup of patients who received aspirin preoperatively. In both aprotinin groups, there was a non-significant trend toward increased risk of Q-wave myocardial infarction. In six of 12 vein grafts studied at post-mortem examination from aprotinin-treated patients, acute vein graft thrombosis was found. This was not seen in any of five grafts from placebo-treated patients. In conclusion, aprotinin significantly reduces bleeding and transfusion requirements in patients undergoing repeat myocardial revascularization. The non-significantly increased risk of graft thrombosis requires further study.
Use of aprotinin in lung transplantation
Authors: Cooper Joel D
Published: January 2017

Although the use of aprotinin has been well documented for cardiac surgical procedures, its use in lung transplantation has received less attention. Herein is the experience at Washington University with aprotinin in patients undergoing lung transplantation (most with cystic fibrosis). In these patients, bleeding from the chest wall is a major problem due to the dense adhesions from chronic infection. Aprotinin has a dramatic effect in reducing bleeding.
Multidisciplinary management from day one: the Neuro-care approach to motor neurone disease
Authors: Oxtoby Marie , Eikaas Marit
Published: January 2017

The Neuro-care approach offers a holistic, multidisciplinary, patient-centred, continuous strategy of care to unselected groups of neurological patients and their families including those with motor neurone disease (MND).

The strategy for MND patients is an adapted version of one piloted on patients with Parkinson's disease. Between April 1990 and September 1992 12 MND patients were diagnosed, of whom five have died.

The main features of the care strategy and the guidelines for giving the diagno sis are described. The characteristics of the patient group are identified and the high level of team activity vis-a-vis other patient groups is noted. The maintenance of patients in the community and the lack of resort to permanent institutional care are also recorded.

Ethical issues arising during the project are discussed and the problems of measuring outcomes of care are acknowledged. General conclusions for MND management are drawn.
Victim Participation in Sentencing: And the Debate Goes On …
Authors: Erez Edna
Published: January 2017

The right of victims in adversarial legal systems to provide input into sentencing decisions is still controversial. The paper presents the various forms victim input takes and the arguments for and against its use in sentencing. It then surveys the relevant research that has addressed these arguments and examines the implementation of this right. The article concludes that victim input may have some beneficial results for victims and for the justice system, without any of the predicted adverse effects on them.
The Position of the Victim in Criminal Procedure — Results of a German Study
Authors: Kury Helmut , Kaiser Michael , Teske Raymond
Published: January 2017

In the last few years, the crime victim has moved into the forefront of criminological research and criminal justice policy. This is a worldwide development. In many countries, including the Federal Republic of Germany, victim protection and victim compensation laws have been enacted. The extent to which such legal steps effect an actual improvement of the victims' situation remains largely unexamined. This paper presents the results of a German research project which examined the influence of the recently revised German victim protection law upon criminal law practice. Judges, prosecutors and lawyers were surveyed. A clear resistance by judges and prosecutors was discerned relative to implementing the victim protection rights. For them, the victim is still an outsider and a ‘trouble maker’ within the criminal proceedings. They see increased victim attention as involving additional trouble, effort, time, and possibly creating longer delays in proceedings. In contrast, the attitudes of the attorneys were more favorable toward including the victim in the criminal justice process.
Team-based data management instruction at small liberal arts colleges
Authors: Clement Ryan , Blau Amy , Abbaspour Parvaneh , Gandour-Rood Eli
Published: January 2017

This paper describes a collaborative approach taken by librarians at five small, regional liberal arts colleges to developing/enhancing research data management services on their campuses. The five colleges collectively belong to a consortium known as the Northwest Five Consortium. Over 10 months, librarians from the five schools collaborated to plan a data management and curation workshop with the goals of developing relationships with researchers working with data, developing their own research data management skills and services, and building a model for future training and outreach around institutional research data management services. This workshop brought together research teams including faculty, students, and librarians, and incorporated active learning modules as well as in-depth pre-workshop discussion. This article will discuss the context and background for this workshop, the model itself, and the outcomes and possibilities for future developments.
Divorce, Bureaucracy, and Emotional Frontiers
Authors: Vallgårda Karen
Published: January 2017

Through a reading of administrative separation and divorce cases from late nineteenth-century Denmark, this article examines the emotional practices of separating couples interacting with the state bureaucracy. The argument is that, unlike in other European countries where achieving divorce depended on faultfinding, the Danish law, the bureaucratic procedures, and the state officials, who administered them, promoted polite emotional practices of divorce. While some couples easily met these standards, others encountered an emotional frontier and struggled to align their affective behavior with the emotional–legal logic of the law. The analysis shows a delicate dialectic between emotional practices and social class.
Diverse Marriage Patterns in Imperial Germany
Authors: Gavalas Vasilis , Tscheulin Thomas
Published: January 2017

Based on the German census of 1900, this article describes marriage patterns in Imperial Germany. The general marriage pattern did not markedly deviate from the “European” one. Nevertheless, the analysis uncovered interesting geographical variation. The male pattern presented differentiation between eastern and western Germany, with levels of male permanent celibacy being lower in the eastern parts of the Empire. However, the extent of female permanent celibacy was great, especially in Prussia. This is probably associated with a dearth of males at marriageable ages due to historical circumstances (migration and wars that decimated young males) in the 1860s and early 1870s.
B.R. Ambedkar
Authors: Chakrabarty Bidyut
Published: January 2017

B.R. Ambedkar (1891–1956) pursued a scathing critique against the dominant nationalist discourse that Gandhi shaped, to a significant extent. Unlike Gandhi who insisted on village swaraj, Babasaheb preferred liberal democracy of the Western variety in which an individual remained the basic unit of governance. What he established in the 1950 Constitution of India had its beginning in Ambedkar’s witness before the 1919 Southborough Committee and the 1930–32 Round Table Conference. This was a political battle that he had waged against the Mahatma to substantiate his arguments in favour of liberalism. There was also another battle that he was engaged in while challenging ‘the archaic social values’ supportive of caste discrimination. On the basis of his thorough research, he reinvented the idea of social justice in tune with his firm commitment to liberalism. True that he did not always succeed in his mission; nonetheless, the debate between the Mahatma and Babasaheb testifies several new dimensions of India’s nationalist thought that did not, so far, receive adequate scholarly attention. By drawing on a rather neglected aspect of the nationalist debate, the article seeks to fill up in our understanding of the ideas of Gandhi and Ambedkar which were definitely context driven. This is also a textual study that also makes the point that Ambedkar’s ideas did not appear to be as significant as they later became in independent India presumably because of the hegemonic influence of Gandhi in the nationalist universe probably due to contextual reasons.
The Negative Symptoms of Schizophrenia: A Cognitive Perspective
Authors: Rector Neil A , Beck Aaron T , Stolar Neal
Published: January 2017

Recent reports of improvement in the negative symptoms of schizophrenia following targeted cognitive interventions have prompted interest in the cognitive underpinnings of these symptoms. This review integrates current experimental research with the phenomenological accounts of patients participating in cognitive therapy for these specific symptoms. We propose that, in addition to the well-established role of neurobiological factors in their development and maintenance, specific cognitive appraisals and beliefs play a role in the expression and persistence of negative symptoms. This cognitive model of negative symptoms is based on a diathesis–stress formulation: a continuum of predispositional traits from the premorbid personality to the full-blown negative symptomatology, the incorporation of negative social and performance attitudes within these traits, and low expectancies for pleasure or success in goal-oriented activities. We suggest that negative symptoms represent, in part, a compensatory pattern of disengagement in response to threatening delusional beliefs, perceived social threat, and anticipated failure in tasks and social activities. A psychological aspect of this motivational and behavioural inertia appears to be the patient's perception of limited psychological resources—a perception that motivates patients to conserve energy by minimizing investment in activities requiring effort.
Environmental Cognitive Remediation in Schizophrenia: Ethical Implications of “Smart Home” Technology
Authors: Stip Emmanuel , Rialle Vincent
Published: January 2017

Objective:

In light of the advent of new technologies, we proposed to reexamine certain challenges posed by cognitive remediation and social reintegration (that is, deinstitutionalization) of patients with severe and persistent mental disorders.

Method:

We reviewed literature on cognition, remediation, smart homes, as well as on objects and utilities, using medical and computer science electronic library and Internet searches.

Results:

These technologies provide solutions for disabled persons with respect to care delivery, workload reduction, and socialization. Examples include home support, video conferencing, remote monitoring of medical parameters through sensors, teledetection of critical situations (for example, a fall or malaise), measures of daily living activities, and help with tasks of daily living. One of the key concepts unifying all these technologies is the health-smart home. We present the notion of the health-smart home in general and then examine it more specifically in relation to schizophrenia.

Conclusion:

Management of people with schizophrenia with cognitive deficits who are being rehabilitated in the community can be improved with the use of technology; however, such technology has ethical ramifications.
Psychological Treatments for Social Phobia
Authors: Rowa Karen , Antony Martin M
Published: January 2017

Objective:

To review the empirical status of psychological treatments for social phobia (SP), commenting both on cognitive-behavioural interventions and on more recent iterations of those approaches. We also review the effective components of cognitive-behavioural therapy (CBT).

Method:

We qualitatively reviewed the empirical literature on the psychological treatment of SP. We include empirical studies, metaanalyses, and recent conference presentations in this review.

Results:

Cognitive and behavioural interventions for SP appear to be more effective than wait-list controls and supportive therapy. Comparisons of CBT and pharmacologic treatment have produced inconsistent results. Several new treatments for SP demonstrate promising results.

Conclusion:

Evidence suggests that various psychosocial treatments for SP are better than wait-list controls and credible placebo interventions. Ongoing projects investigate the relative efficacy of combining medication and psychosocial treatments over monotherapies; this line of research is important to continue. Further research should also focus on which components of CBT are most effective.
Are Dexamethasone Suppression Test Nonsuppression and Thyroid Dysfunction Related to a Family History of Dementia in Patients with Major Depression? An Exploratory Study
Authors: Fountoulakis Konstantinos N , Kaprinis Stergios G , Iacovides Apostolos , Phokas Konstantinos , Kaprinis George
Published: January 2017

Objective:

Recent data suggest that the low thyroid function syndrome in depression is nonspecific, They also suggest that depression may constitute a risk factor for the development of dementia, especially in atypical patients who have high rates of hypothalamo–pituitary–adrenal axis disorders. This study aimed to search for correlations among Dexamethasone Suppression Test (DST) cortisol levels, thyroid indices, and family history of dementia in patients with depression.

Methods:

A sample of 30 patients, aged 21 to 60 years and suffering from major depression according to DSM-IV criteria, took part in the study. Three had a family history of dementia in first-degree relatives. We measured their serum levels of free T3, free T4, thyroid-stimulating hormone, thyroid binding inhibitory immunoglobulines, thyroglobulin antibodies, and thyroid microsomal antibodies (TMAs). We applied the 1-mg DST to all patients. The statistical analysis included 1-way multivariate analysis of covariance using t tests as the post hoc tests.

Results:

Significantly higher levels of TMAs were found in patients with a family history of dementia, compared with those who did not have this family history.

Conclusion:

The results of this study suggest that a more pronounced autoimmune process may characterize depression patients with a family history of dementia.
Ropinirole in Treatment-Resistant Depression: A 16-Week Pilot Study
Authors: Cassano Paolo , Lattanzi Lorenzo , Fava Maurizio , Navari Serena , Battistini Giulia , Abelli Marianna , Cassano Giovanni B
Published: January 2017

Objective:

The study aimed to assess the antidepressant efficacy and tolerability of adjunctive ropinirole in outpatients with treatment-resistant depression (TRD).

Method:

The study sample consisted of patients with a major depressive episode (diagnosed according to DSM-IV criteria) and TRD. Ropinirole 0.25 to 1.5 mg daily was added to tricyclic antidepressants or selective serotonin reuptake inhibitors. We conducted assessments at baseline and at weeks 2, 4, 8, 12, and 16. We defined response as a 50% or greater reduction of the Montgomery–Asberg Depression Rating Scale (MADRS) total score plus a score of 1 (“very much improved”) or 2 (“much improved”) on the Clinical Global Impression of Improvement scale at endpoint. Tolerability was monitored with the Dosage Record Treatment Emergent Symptom Scale.

Results:

Seven patients had major depressive disorder, and 3 had bipolar II disorder. The mean maximum dose of ropinirole was 1.33 mg daily. Mean (SD) scores on the MADRS decreased from 29.6 (7.6) at baseline to 16.9 (12.1) at endpoint ( P < 0.02). At endpoint, 4 of 10 (40%) patients were responders. Two patients discontinued ropinirole because of dizziness.

Conclusions:

These pilot data suggest that, in selected cases of TRD, ropinirole augmentation of antidepressants is effective and relatively well tolerated.
SCL-90-R and 16PF Profiles of Senior High School Students with Excessive Internet Use
Authors: Yang Chang-Kook , Choe Byeong-Moo , Baity Matthew , Lee Jeong-Hyeong , Cho Jin-Seok
Published: January 2017

Objective:

To investigate the psychiatric symptomatology and personality characteristics of Korean senior high school students considered to use the Internet to excess.

Method:

We administered a questionnaire packet to students that included 4 measures. These measures included a questionnaire on Internet use patterns during the previous month, the Internet Addiction Test (IAT), the Symptom Checklist-90-R (SCL-90-R), and the Sixteen Personality Factor Questionnaire (16PF). A total of 328 students, aged 15 to 19 years, participated in the study.

Results:

Students were divided into 4 Internet user groups according to their IAT total scores: nonusers ( n = 59, 18.0%), minimal users ( n = 155, 47.3%), moderate users ( n = 98, 29.9%), and excessive users ( n = 16, 4.9%). The SCL-90-R showed that the excessive users group, when compared with the other groups in this study, reported the highest levels of symptomatology. The 16PF also revealed that excessive users were easily affected by feeling, emotionally less stable, imaginative, absorbed in thought, self-sufficient, experimenting, and preferred their own decisions.

Conclusions:

This study suggests that senior high school students who use the Internet to excess report and subsequently exhibit significantly more psychiatric symptoms than students who use the Internet less frequently. In addition, excessive users appear to have a distinctive personality profile when compared with nonusers, minimal, and moderate users.
Spontaneous Parkinsonism in Antipsychotic-Naive Patients with First-Episode Psychosis
Authors: Chong Siow Ann , Subramaniam Mythily , Verma Swapna
Published: January 2017

Objective:

The purpose of this study was to establish rates of spontaneous parkinsonism (SP) among the different types of psychosis. We hypothesized that the rate would be higher among persons with affective symptoms.

Methods:

We included in the study consecutive patients admitted to a first-episode psychosis intervention program. We recorded sociodemographic data from interviews with patients and caregivers and from medical records. We used the Simpson–Angus Rating Scale at baseline to assess parkinsonism and a diagnosis of SP was established if the Simpson–Angus score was ≥ 0.3.

Results:

A total of 174 patients were examined; of these, only 4 (2.3%; 2 Chinese women, 1 Chinese man, and 1 Malay man) had SP. There was a significant difference in the rates of SP in patients with affective psychosis and schizoaffective disorder, compared with those with nonaffective psychoses (15.4% vs 1.2%; χ2 = 10.7, P = 0.001). The 2 groups did not differ significantly in age, duration of untreated psychosis, or sex distribution.

Conclusions:

The rate of SP in Asian patients with first-episode psychosis was low, and it was significantly higher in those with affective symptoms.
Inattention, Hyperactivity, and Impulsivity in Teenagers with Intellectual Disabilities, with and without Autism
Authors: Bradley Elspeth A , Isaacs Barry J
Published: January 2017

Objective:

To explore inattentive, hyperactive, and impulsive behaviours in teenagers with intellectual disabilities (ID), with and without autism.

Method:

We identified teenagers with ID, with and without autism, in a single geographic area. Those with autism were matched for age, sex, and nonverbal IQ to those with ID only. We compared inattentive, hyperactive, and impulsive (IHI) behaviours in the 2 groups, along with adaptive functioning and medical circumstances. We further subdivided the autism group into those with IHI behaviours (autism IHI) and those without (autism non-IHI) and explored similarities and differences between autism subgroups.

Results:

As a group, those with autism and ID had more IHI behaviours than those with ID alone. More in the autism group met criteria for attention-deficit hyperactivity disorder and hyperkinetic syndrome. Lifetime exposure to psychotropic medication was greater in the autism group, with stimulant and antipsychotic medications predominating. However, just under one-half of those in the autism group showed no IHI behaviours. Comparison of autism IHI and autism non-IHI groups showed that those with IHI behaviours were significantly more likely to have past (but not current) exposure to stimulant medication.

Conclusions:

One in 2 teenagers with ID and coexisting autism displayed clinically significant inattentive, hyperactive, and (or) impulsive behaviours, compared with 1 in 7 of those with ID alone. Most of the remaining teenagers with autism displayed no IHI behaviours. Our results support the need for further investigation into the prevalence and etiology of these IHI behaviours in individuals with autism.
Electroconvulsive Therapy in Older Adults: 13-Year Trends
Authors: Rapoport Mark Jeffrey , Mamdani Muhammad , Herrmann Nathan
Published: January 2017

Objectives:

To examine temporal trends in electroconvulsive therapy (ECT) use among all 12 million Ontario residents between January 1992 and December 2004 and to examine the differential trends in older adults, compared with younger ones.

Methods:

We undertook a time-series analysis to examine annual trends in the use and prevalence of ECT, using linked provincial datasets. Descriptive data were presented for the population as a whole, and then trends were described separately by age groups (younger and older). As a comparator, we similarly examined antidepressant prevalence for older adults over the same time period.

Results:

Overall rates of ECT prevalence were stable. Annual population rates of individuals receiving ECT increased by about 27%, from 12.3 per 100 000 population in 1992 to 15.6 per 100 000 in 1997, and then decreased to 12.5 per 100 000 by 2004. The population rates of ECT were about threefold higher among older adults, relative to the younger population. Antidepressant prevalence increased by 90.1% among older adults over the same time period. The female-to-male ratio was relatively stable over time.

Conclusions:

The rate of ECT has been relatively stable since the early 1990s. Older adults were much more likely to be prescribed a course of ECT than younger adults. ECT remains a commonly prescribed treatment, particularly in old age.
Definition, Assessment, and Staging of Treatment—Resistant Refractory Major Depression: A Review of Current Concepts and Methods
Authors: Berlim Marcelo T , Turecki Gustavo
Published: January 2017

Objective:

Up to 15% of depression patients eventually present with treatment-resistant or refractory depression (TRD), a condition that causes significant social and economic burdens. Our paper aims to summarize the current medical literature on the conceptual and methodologic issues involved in the definition, assessment, and staging of TRD.

Method:

We reviewed the recently published medical literature to identify papers that specifically discuss TRD. For this, we searched MEDLINE, EMBASE, and PsycINFO for potentially relevant English-language articles published between January 1996 and June 2006.

Results:

Recent methodologic and conceptual advances have contributed to the achievement of an acceptable level of theoretical consensus on the general meaning of TRD. Accordingly, depression is usually considered resistant or refractory when at least 2 trials with antidepressants from different pharmacologic classes (adequate in terms of dosage, duration, and compliance) fail to produce a significant clinical improvement. Regarding diagnostic assessments, an accurate and systematic evaluation should be made to elicit the potential role of several contributing factors, such as medical and psychiatric comorbidity.

Conclusion:

Recently, 3 staging methods for TRD have been described, but they currently require extensive empirical support. Future research on TRD should include prospective studies addressing the validity of the proposed criteria, the impact of depression comorbid with other psychiatric disorders and (or) physical conditions, and the possible predictors of treatment outcome. There is an important and clear need for studies that empirically test current definitions, assessment strategies, and staging methods of TRD.
A National Survey of Canadian Psychiatry Residents' Perceptions of Psychotherapy Training
Authors: Hadjipavlou George , Ogrodniczuk John S
Published: January 2017

Objective:

To explore Canadian psychiatry residents' perceptions of their psychotherapy training and identify factors that may influence decisions to practise psychotherapy after graduation.

Method:

We surveyed psychiatry residents at all training sites across Canada, using a self-report questionnaire.

Results:

The response rate was 63%. Of the respondents, 68% indicated that the prospect of learning and practising psychotherapy was a factor in their decisions to become psychiatrists, and 87% considered their ability to practise psychotherapy to be important to their identities as psychiatrists. The majority of residents (71%) were generally satisfied with their psychotherapy training. Among the graduating class of residents, 84% anticipate practising psychotherapy in some capacity. Satisfaction with their overall training experience and supervision and feeling competent to perform psychotherapy were significantly associated with their decisions to practise psychotherapy after graduation.

Conclusions:

Most psychiatry residents currently enrolled in postgraduate training programs across Canada view psychotherapy as having an important role in the way they anticipate practising psychiatry.
Epidemiology of Schizophrenia
Authors: Häfner Heinz , an der Heiden Wolfram
Published: January 2017

Objective:

To characterize the epidemiology of schizophrenia.

Method:

Narrative literature review.

Results:

Each year 1 in 10 000 adults (12 to 60 years of age) develops schizophrenia. Based on a restrictive and precise definition of the diagnosis and using standardized assessment methods and large, representative populations, the incidence rates appear stable across countries and cultures and over time, at least for the last 50 years. Schizophrenic patients are not born into ecological and social disadvantage. The uneven distribution of prevalence rates is a result of social selection: an early onset leads to social stagnation, a late onset to descent from a higher social status. The main age range of risk for schizophrenia is 20 to 35 years. It is still unclear whether schizophrenia-like late-onset psychoses (for example, late paraphrenia) after age 60 should be classified as schizophrenia either psychopathologically or etiologically. In 75% of cases, first admission is preceded by a prodromal phase with a mean length of 5 years and a psychotic prephase of one year's duration. On average, women fall ill 3 to 4 years later than men and show a second peak of onset around menopause. Consequently, late-onset schizophrenias are more frequent and more severe in women than in men. The sex difference in age of onset is smaller in cases with a high genetic load and greater in cases with a low genetic load. Type of onset and core symptoms do not differ between the sexes. The most pronounced sex difference is the socially negative illness behaviour of young men.

Conclusions:

Among the factors determining social course and outcome are level of social development at onset, the disorder itself (for example, genetic liability, severity of symptoms, and functional deficits), general biological factors (for example, estrogen), and sex- and age-specific illness behaviour.
Psychosocial Aspects of Coronary Artery Disease Related to Military Patients
Authors: Grenier Jodi L , Swenson J Robert , FitzGibbon GM , Leach Alan J
Published: January 2017

Objective:

Coronary artery disease (CAD) is a major cause of nontraumatic morbidity and mortality in military personnel. Most studies of the psychosocial impact of CAD have dealt with civilian populations. The purpose of this paper is to highlight differences between military and civilian populations with CAD in 4 areas: depression and anxiety, social support, return to work, and stress.

Method:

A computerized literature search from 1985 to 1995 using the search terms “stress,” “cardiovascular,” “cardiac,” “depression,” “military,” “anxiety” and “psychosocial” was undertaken. Controlled and prospective studies of civilian patients were selected along with relevant studies involving military populations.

Results:

Unique characteristics of the military may be important factors in affecting the psychosocial outcome of military patients with CAD. These characteristics include a high level of denial of illness, strong social supports, a powerful military work ethic, and stressful situations unique to the military.

Conclusions:

Most studies of the psychosocial impact of CAD are based on civilian populations. A review of available studies suggests that little is known about how military patients adapt to CAD, particularly with regard to symptoms of depression and anxiety, social impairment, and rates of return to work. Studies in this area are needed regarding the psychosocial aspects of CAD in military populations.
Nature of Pathology: The Character of Danger Implicit in Functional Impairment
Authors: Leighton Alexander H , Murphy Jane M
Published: January 2017

Objective:

To facilitate clinical and scientific consensus in definitions of psychiatric disorders and with regard to the nature and meaning of pathology more generally.

Method:

An essay based on a review of definitional problems encountered by psychiatric epidemiologists, with examples taken from selected studies of historic importance. A remedy is suggested and illustrated by experiences with its use in the Stirling County Study.

Results:

A concept of pathology, termed for reference as “impairment-risk,” is defined as the danger that functional impairment carries for subsequent health adversities. The concept is based on the classical notions of Rudolf Virchow, the empirical orientations of Adolf Meyer's psychobiology, the functional concepts of physiology, and the dynamics implied by evolutionary biology. The ideas embedded in “impairment-risk” are beginning to be represented in official classifications of mental disorders.

Conclusions:

Impairment-risk has potential in the further development of psychiatric epidemiology because of the connections made possible among neuroscience, genetics, general medicine, psychology, and the more empirical of the social and behavioural sciences.
The Nature of Generalized Anxiety Disorder and Pathological Worry: Current Evidence and Conceptual Models
Authors: Brown Timothy A
Published: January 2017

Objective:

To examine the nature and conceptualization of generalized anxiety disorder (GAD) and chronic worry as well as data bearing on the validity of GAD as a distinct diagnosis.

Method:

Narrative literature review.

Results:

Although a wealth of data have been obtained on the epidemiology, genetics, and nature of GAD, many important questions remain regarding the validity of current conceptual models of pathological worry and the discriminability of GAD from certain emotional disorders (for instance, mood disorders) and higher-order trait vulnerability dimensions (for example, negative affect).

Conclusion:

Because the constituent features of GAD are salient to current conceptual models of emotional disorders (for example, models that implicate negative affect or worry/anxious apprehension as vulnerability factors), research on the nature of GAD and its associated features should provide important information on the pathogenesis, course, and cooccurrence of the entire range of anxiety and mood disorders.
The Incidence of Delirium in Psychiatric Inpatient Units
Authors: Patten Scott B , Williams Jeanne VA , Haynes Laura , McCruden Jane , Arboleda-Flórez Julio
Published: January 2017

Objectives:

To estimate prospectively the incidence of delirium in psychiatric inpatients and to identify risk factors for delirium in this population.

Method:

The subjects were nondelirious patients newly admitted to the Calgary General Hospital. The Delirium Symptom Interview (DSI), the Confusion Assessment Method (CAM), and the Mini-Mental State Examination (MMSE) were used to identify incident cases of delirium. In order to evaluate the potential impact of selection bias, we conducted a supplementary analysis using record linkage to an electronic administrative data base with coverage of the target population.

Results:

Of 420 admissions to the hospital, 401 subjects provided informed consent and were not delirious at the time of admission. There were 9 incident cases of delirium. The cumulative incidence rate was, therefore, 2.14 per 100 admissions. The record linkage analysis did not uncover evidence of selection bias. Delirium was associated with a significantly increased length of stay in hospital.

Conclusions:

Delirium is an uncommon incident event in the psychiatric inpatient population. The incidence rate reported here may be useful as a benchmark for the identification of excessive rates in other inpatient settings. Since delirium is sometimes related to modifiable therapeutic factors, an excessive rate should prompt a search for its causes.
Behaviour Therapy for Obsessive—Compulsive Disorder: A Decade of Progress
Authors: Marks Isaac
Published: January 2017

Objective:

To review the last decade of behaviour therapy research in obsessive–compulsive disorder (OCD).

Method:

The most salient research was analyzed.

Results:

Many studies confirmed that exposure and ritual prevention (ERP) effectively reduced compulsive rituals and obsessive thoughts in most patients in all age groups, although a minority of the patients did not complete treatment. Gains persisted to follow-up 2 to 6 years later in several countries. Improvement after ERP generalized to obsessive–compulsive beliefs, mood, work, and social adjustment, and was accompanied by reduction in cerebral blood flow in the right caudate nucleus. Teaching patients how to prevent relapse seems to reduce the risk of recurrence. ERP yields slightly more improvement than does appropriate antidepressant medication and is followed by far less relapse after treatment has stopped, so ERP may be more cost-effective in the long term. Antidepressant medication is a useful adjunct to ERP when OCD is accompanied by comorbid depression. The therapist now tends to teach patients how to carry out self-exposure and self-imposed ritual prevention, rather than to impose ERP on them. Self-help manuals help patients to do this, and computer aids to allow patients to learn how to do ERP at home have been valuable in pilot studies. Cognitive therapy without ERP was as useful as ERP.

Conclusion:

ERP is of lasting value for OCD. Long-term cost-effectiveness comparisons are needed of self-administered ERP versus cognitive therapy and versus medication. Studies are also needed of brief psychological treatment for depression comorbid with OCD.
Neurocognitive Correlates of Positive and Negative Syndromes in Schizophrenia
Authors: Voruganti LNP , Heslegrave RJ , Awad AG
Published: January 2017

Objective:

To identify the neurocognitive correlates of positive and negative schizophrenic syndromes using a battery of information-processing measures as the principal method of evaluation.

Method:

Fifty-two treated, symptomatically stable, schizophrenic (DSM-III-R) patients and 24 age-matched, healthy volunteers were administered a computerized cognitive test battery (COGLAB). The battery included measures of preattentional, attentional, conceptual, and psychomotor performance. The patients' psychopathology was rated with the positive and negative syndromes scale (PANSS), which derived scores for positive symptoms, negative symptoms, general psychopathology, and insight.

Results:

Compared with controls, schizophrenic patients, as a group, showed significant deficits on all of the neurocognitive tasks. Impaired performance on the backward masking, span of apprehension, and Wisconsin card sorting tasks correlated significantly with negative symptoms (r = 0.27–0.40), general psychopathology (r = 0.29–0.42) and impaired insight (r = 0.34–0.52), but no clear association was found between positive symptom scores and neurocognitive deficits.

Conclusions:

Schizophrenic patients with predominantly negative symptoms and impaired insight seem to exhibit more severe neurocognitive deficits, which lends support to the evolving concept of schizophrenia subtypes and their distinctive neurobiological mechanisms.
Toward an Affirmative Biopolitics
Authors: Tierney Thomas F.
Published: January 2017

This essay responds to German theorist Thomas Lemke’s call for a conversation between two distinct lines of reception of Foucault’s concept of biopolitics. The first line is comprised of sweeping historical perspectives on biopolitics, such as those of Giorgio Agamben and Antonio Negri, and the second is comprised of the more temporally focused perspectives of theorists such as Paul Rabinow, Nikolas Rose, and Catherine Waldby, whose biopolitical analyses concentrate on recent biotechnologies such as genetic techniques and the biobanking of human tissues. This essay develops this conversation by bringing the two lines to bear on the neoliberal “bioeconomy” that has developed over the past three decades and uses the perspective of Italian theorist Roberto Esposito to represent the first line. Esposito’s unique combination of Foucauldian biopolitics and the Maussean gift tradition provides a critical perspective that engages and challenges the neoliberal inclination of many theorists from the second line.
The QuickLift: Featuring an Encircling Double Purse-String Plication Technique with Blunt Neck/Jowl Undermining and Small Submental Tuck for Tightening the Sagging Superficial Musculoaponeurotic System, Platysma, and Skin
Authors: Brandy Dominic A.
Published: January 2017

Introduction:

The QuickLift is a modification of the S-lift that varies from the S-lift primarily in the shape of the incision, the areas of undermining, the method of plication, and the vector of advancement. Two negative aspects of the purse-string plication technique used with the original QuickLift were an intraoperative bulging centrally that required trimming and minimal midface improvement. In 1 of the 85 patients reported in the original article, the aforementioned complication became noticeable as a slight bulge once swelling subsided.

Materials and Methods:

Instead of using 1 large oval-shaped purse string for plication, a firmly anchored small oval-shaped purse-string is encircled by a larger purse-string, with the latter purse-string modified to provide improved advancement of the midface.

Results:

The encircling double purse-string plication technique not only reduces the bulging effect of the deep tissues, but also provides stronger soft tissue support because of increased suture placement and anchoring sites. The cosmesis in the midface is improved over the former technique.

Conclusions:

A new variation of the originally described QuickLift plication technique reduces bulging of the deep tissues while simultaneously providing stronger superficial musculoaponeurotic system support to the neck, jowls, and midface. Blunt undermining or liposuction of the neck and/or jowl with a small submental tuck further enhances the result.
Complications of Long-Lasting Facial Fillers
Authors: Saylan Ziya
Published: January 2017

Introduction:

Although facial fillers have been popular for years, some complications have been associated with their injection or inappropriate application. Because these products are so long lasting, such untoward consequences would be difficult or impossible to correct without surgical intervention. Despite the attractions that longevity and permanency offer, the long-term effects of injecting long-lasting fillers such as acryl pearls and polyacrylamide facial filler materials deserve serious consideration by both physicians and patients before injection treatment is initiated. The author presents in this article the results of his research into possible adverse reactions to facial fillers.

Methods and Materials:

A total of 110 patients were selected for this study, and each received an injection into a single location on the face. Ten patients were treated with Artecoll and 100 patients were treated with Dermalive (n = 50) and Dermadeep (n = 50). The injections were made in the glabella, nasolabial fold, lips, perioral, cheeks, and chin. To achieve a more accurate study result, injection into a single area of the face at a time was necessary.

Results:

Between 1992 and 2003, 57 patients presented with problems after acryl injections into the face. The granulomas caused by Artecoll were smaller and fewer than those caused by Dermalive and Dermadeep.

Discussion:

Two products that are relatively new to the esthetic treatment industry are poly-L-lactic acid, also known by the product names Sculptra in the United States and New-Fill in Europe, and hydrophilic polyacrylamide gel, known by the product names Bio-Alcamid, Amazingel, and Aqua-Mid. These materials also form granulomas. The ethical question about whether we as surgeons should implant materials into the face that we can never completely remove without damaging the surrounding healthy tissue should be discussed further.

Conclusions:

Permanent fillers that provide satisfactory results at first may become more visible or create an unnatural appearance as aging progresses. Because these products are so long lasting, such untoward consequences would be difficult or impossible to correct without surgical intervention. Given these problems, it is legitimate to question the necessity for such permanent fillers.