bluuebunny/crossref_metadata_2025 huggingface dataset:
Intravitreal Infliximab for Choroidal Neovascularization in Patients Refractory to Conventional Treatments
Authors: Semeraro F. , Romano M.R. , Danzi P. , Angi M. , Costagliola C.
Published: January 2017

The aim of the study is to evaluate the effectiveness and safety of intravitreal infliximab in the course of compassionate use in patients affected by choroidal neovascularization. This prospective interventional case series includes four eligible patients, affected by exudative age-related macular degeneration (2/4), retinal angiomatous proliferation (1/4) and central retinal vein occlusion (1/4), who were refractory to conventional treatments. The patients received a single intravitreal injection of 0.05 ml of reconstituted infliximab solution (20mg/ml). The main outcomes measure were changes in best-corrected visual acuity and central retinal thickness. Patients were evaluated at baseline, every week for the first month, then every two weeks, and on demand. Morphologic parameters improved after a single infliximab intravitreal injection. However, all patients developed acute uveitis in a period ranging from 4 to 7 weeks after treatment. Control of the intraocular inflammation was achieved with topical and systemic steroids in 3 patients, whereas in one case pars plana vitrectomy was needed. A single intravitreal injection of infliximab does not seem to improve the natural history of CNV from different aetiologies. However, all patients in our series developed a serious inflammatory response that required surgical management in one case. The intravitreal administration of infliximab is hence not safe and not recommended in clinical practice.
Comparison of Manual Methods of Extracting Genomic DNA from Dried Blood Spots Collected on Different Cards: Implications for Clinical Practice
Authors: Molteni C.G. , Terranova L. , Zampiero A. , Galeone C. , Principi N. , Esposito S.
Published: January 2017

Isolating genomic DNA from blood samples is essential when studying the associations between genetic variants and susceptibility to a given clinical condition, or its severity. This study of three extraction techniques and two types of commercially available cards involved 219 children attending our outpatient pediatric clinic for follow-up laboratory tests after they had been hospitalised. An aliquot of venous blood was drawn into plastic tubes without additives and, after several inversions, 80 μL were put on circles of common paper cards and Whatman FTA-treated cards. Three extraction methods were compared: the Qiagen Investigator, Gensolve, and Masterpure. The best method in terms of final DNA yield was Masterpure, which led to a significantly higher yield regardless of the type of card (p<0.001), followed by Qiagen Investigator and Gensolve. Masterpure was also the best in terms of price, seemed to be simple and reliable, and required less hands-on time than other techniques. These conclusions support the use of Masterpure in studies that evaluate the associations between genetic variants and the severity or prevalence of infectious diseases.
Modulation of Polyfunctional HIV-Specific CD8 T Cells in Patients Responding Differently to Antiretroviral Therapy
Authors: Casetti R. , De Simone G. , Sacchi A. , Bordoni V. , Viola D. , Rinaldi A. , Agrati C. , Gioia C. , Martini F.
Published: January 2017

Antiretroviral therapy allows a restoration of immune cell homeostasis associated with a normal immune competence. Our goal was to analyze the modulation of polyfunctional HIV-specific CD8+ T-cell responses during antiretroviral therapy. HIV-infected individuals were divided into four groups according to CD4+ cell count and viral load at the moment of recruitment. Whole blood was stimulated with a pool of CD8-specific HIV-antigens to assess cytokine/chemokine production and cytotoxicity activity by using flow cytometry. The groups show different modulation in HIV-specific CD8+ T-cell responses. In particular, immunological failure showed different distributions of polyfunctional HIV-specific CD8+ responses, mainly due to an increase of cells producing CD107a/IFN/γ/IL-2/MIP-1β. Our results indicate that this particular 4+ functional subset is a possible correlate of immunological failure. Considering the complexity of interactions among HAART, immune system and HIV, work is in progress to find correlates of therapy efficacy.
Safety and Infectious Prophylaxis of Intravenous Immunoglobulin in Elderly Patients with Membranous Nephropathy
Authors: Molinaro I. , Barbano B. , Rosato E. , Cianci R. , Di Mario F. , Quarta S. , Sardo L. , Salsano F. , Amoroso A. , Gigante A.
Published: January 2017

A variety of infections has been recognized as an important cause of morbidity and mortality in patients with nephrotic syndrome, and membranous nephropathy is a common cause of this in the elderly. The reasons for infection risk are due to oedema complications, urinary loss of factor B and D of the alternative complement pathway, cellular immunity, granulocyte chemotaxis, hypogammaglobulinemia with serum IgG levels below 600 mg/dL, and secondary effects of immunosuppressive therapy. Many different prophylactic interventions have been used for reducing the risks of infection in these patients but recommendations for routine use are still lacking. We report two membranous nephropathy cases in the elderly in which Intravenous immunoglobulin were useful in long-term infectious prophylaxis, showing safety in renal function. During immunosuppressant therapy in membranous nephropathy, intravenous immunoglobulin without sucrose are a safe therapeutic option as prophylaxis in those patients with nephrotic syndrome and IgG levels below 600 mg/dL. The long-term goal of infection prevention in these patients is to reduce mortality, prolong survival and improve quality of life.
Multiple Pulmonary Nodules and Unexplained Fever: When the Pulmonologist Fails
Authors: Mincarini M. , Bagnasco D. , Ferrantino M.G. , Balbi F. , Passalacqua G.
Published: January 2017

We describe herein a difficult case of persistent and refractory fever, associated with multiple lung nodules, progressive respiratory failure and general deterioration. Our patient was carefully investigated for the possible causes of his symptoms, using current and advanced diagnostic procedures, either serological or by imaging. The confirmatory diagnosis of anaplastic T-cell lymphoma, was obtained only after an invasive procedure (with severe pneumothorax), although it was too late. This suggests that also very rare diseases should be considered in the presence of unexplained signs/symptoms, and that in such cases, aggressive diagnostic procedures should be applied as early as possible.
Changes in Extra- and Intracellular pH in Hepatocytes Exposed to Gabexate Mesilate
Authors: Imberti R. , Ferrigno A. , Tartaglia A. , Rizzo V. , Richelmi P. , Vairetti M.
Published: January 2017

Gabexate mesilate (GM) is a synthetic inhibitor of plasmatic and pancreatic serine proteases licensed for the treatment of pancreatitis. Here we show that in suspensions of isolated hepatocytes, profound changes in extracellular, cytoplasmic, and vesicular pH occur after addition of GM. Isolated hepatocytes obtained by collagenase perfusion of rat liver were pre-incubated with 1, 2, and 4 mM GM. Extracellular pH (pH in the incubation medium) was measured by a conventional pH electrode, cytosolic and vesicular pH were measured by fluorescence changes of 2′,7′-biscarboxyethyl-5,6-carboxyfluorescein acetoxymethyl ester (BCECF-AM) and fluorescein dextran, respectively. Incubation of hepatocytes with GM resulted in a dose-dependent decrease of extracellular pH. Cytosolic pH decreased rapidly and markedly in a dose-dependent manner during the first minutes and gradually returned towards baseline. Simultaneously, GM induced a rapid alkalinization of acidic vesicles. The presence of bis-( p-nitrophelyl) phosphate (BNPP), an esterase inhibitor, reduced the extent of extracellular acidification. Incubation of hepatocytes in the presence of dimethylamiloride, an Na+/H+ exchanger inhibitor, or in a sodium-free medium, did not modify the rate and extent of extracellular acidification. GM, a commercially available pharmacological agent, could be useful to manipulate extra- and intracellular pH.
An Antibody Reactivity-Based Assay for Diagnosis of Invasive Candidiasis Using Protein Array
Authors: Ardizzoni A. , Posteraro B. , Baschieri M. C. , Bugli F. , Sáez-Rosòn A. , Manca L. , Cacaci M. , Sterbini F. Paroni , De Waure C. , Sevilla M.J. , Peppoloni S. , Sanguinetti M. , Moragues M.D. , Blasi E.
Published: January 2017

The increased incidence of invasive candidiasis and of patients at risk requires early diagnosis and treatment to improve prognosis and survival. The aim of this study was to set up a ten-protein array-based immunoassay to assess the IgG antibody responses against ten well-known immunogenic C. albicans proteins (Bgl2, Eno1, Pgk1, Pdc11, Fba1, Adh1, Als3, Hwp1, Hsp90 and Grp2) in 51 patients with invasive candidiasis (IC) and in 38 culture-negative controls (non-IC). Antibody levels were higher against Bgl2, Eno1, Pgk1, Als3, Hwp1 and Grp2, than against Adh1, Pdc11, Fba1 and Hsp90, irrespectively of the patient group considered. Moreover, the IgG levels against Bgl2, Eno1, Pgk1 and Grp2 were significantly higher in IC than in non-IC patients. Furthermore, the ROC curves generated by the analysis of the antibody responses against Bgl2, Grp2 and Pgk1 displayed AUC values above 0.7, thus discriminating IC and non-IC patients. According to these results, the employment of the microarray immunoassay (a rapid, sensitive and multiparametric system), in parallel with conventional diagnostics, can help to spot IC patients. This ultimately will allow to initiate an early, focused and optimized antifungal therapy.
Gut Hormones and Endothelial Dysfunction in Patients with Obesity and Diabetes
Authors: Iantorno M. , Campia U. , Di Daniele N. , Nisticò S. , Forleo G.B. , Cardillo C. , Tesauro M.
Published: January 2017

Overweight and obesity are the fifth leading risk for global deaths and its prevalence has doubled since 1980. At least 2.8 million adults, worldwide, die each year as a result of being overweight or obese. The deleterious effects of obesity are tightly related to diabetes, as they are often clinically present in combination to confer increased cardiovascular mortality. Thus, patients with diabetes and obesity are known to develop accelerated atherosclerosis characterized by a dysfunctional endothelium and decreased nitric oxide bioavailability. Recent clinical studies support, indeed, the use of incretin-based antidiabetic therapies for vascular protection. Thus, attention has been focusing on gut hormones and their role, not only in the regulation of appetite but also in vascular health. Intervention directed at modulating these molecules has the potential to decrease mortality of patients with diabetes and obesity. This review will cover part of the ongoing research to understand the role of gut hormones on endothelial function and vascular health.
“FoxP3 Hunting” during Infection with Francisella Tularensis
Authors: D'Elia R.V. , Laws T.R. , Núñez A. , Clark G.C.
Published: January 2017

Francisella tularensis is a Gram-negative intracellular bacterium that can cause acute disease in mouse models of infection when administered via the inhalational route. The immune response to a pulmonary infection is typified by an initial lack of pro-inflammatory cytokines, followed by hypercytokinemia prior to host death. It remains unclear what causes this delay in the host immune response. In this study we determine the presence of FoxP3 regulatory T cells in the lung, liver and spleen following intranasal infection with F. tularensis SCHU S4. In the lung, the site of initial infection, there is an increase in FoxP3+ cells during the first few days of infection and a notable absence of these cells at the point of cytokine storm and death (day 4 post-infection). This coincides with a decrease in the anti-inflammatory cytokine TGF-β and increases of chemokines MIP-1α, MIP-1β and RANTES. In our model, we also observed an overall decrease in the number of regulatory T cells in the spleen, which was not as evident in the liver. Overall, this data suggests that early on in an acute F. tularensis SCHUS4 infection regulatory T cells contribute to a dampening of the pro-inflammatory response, allowing for bacterial replication and spread.
Management and Treatment of Anaphylaxis in Children: Still too Low the Rate of Prescription and Administration of Intramuscular Epinephrine
Authors: Calamelli E. , Mattana F. , Cipriani F. , Ricci G.
Published: January 2017

Despite it being well known that anaphylaxis is a severe life-threatening reaction requiring prompt management and treatment, this entity is still under-recognized and not correctly managed, above all in children. The aim of this study was to analyze the most frequent features of anaphylaxis in a pediatric population (n=65 patients) and to identify factors predicting more severe reactions. Among the 70 recorded episodes, food was the main culprit of anaphylaxis, and patients with a positive history for allergic asthma had more severe episodes ( P=0.008). A self-injectable adrenaline was used only in 2 of the 70 episodes and none of the 50 episodes managed in the Emergency Department was treated with intramuscular adrenaline. Only 10/65 patients (15%) had a prescription for an auto-injector prior to the first episode of anaphylaxis. The retrospective analysis of the risk factors potentially requiring an epinephrine auto-injector prescription before the first anaphylactic episode, showed that of the 55 patients without prescription, at least 10 (18%) should have been provided with a device, according to the most recent guidelines. In conclusion, notwithstanding intramuscular adrenaline being the first-line treatment of anaphylaxis, many episodes are still undertreated and the risk of anaphylaxis is still underestimated. More efforts should be made to promote the correct management of anaphylaxis among both healthcare-providers and patients.
Malignant Melanoma of the Conjunctiva — Successful Surgical Excision of the Primary Tumor and Reconstruction by Conjunctival Auto Transplantation from the Contralateral Eye
Authors: Sivkova N. , Chokoeva A.A. , Dobrev H. , Staribratova D. , Belovezhdov V. , Tchernev G. , Wollina U.
Published: January 2017

Malignant melanoma of the conjunctiva is a rare tumor with incidence of 0.5 cases/year per million population. It may also occur as de novo, as on the basis of preexisting melanocytic lesions (nevus or freckle) or most often from the so-called primary acquired melanosis of the conjuctiva (PAM). It metastasizes mainly lymphogenic and hematogenous. The size of the primary tumor lesion, histopathological findings and absolute tumor thickness are essential for unfavorable prognosis. Conjunctival auto transplantation from the other eye is modern and innovative, but also a seldomly feasible method of reconstruction after conjunctival excision of tumors in this area. We present a rare case of a 75-year-old patient with epithelioid cell malignant melanoma of the bulbar conjunctiva of the right eye, which de novo occurred, successfully treated by excision of the primary tumor and subsequent reconstruction by conjunctival auto transplant from the other eye. A very good therapeutic and aesthetic result was achieved.
Bradykinin B2 Receptor Antagonist off Label Use in Short-Term Prophylaxis in Hereditary Angioedema
Authors: Angeletti C. , Angeletti P.M. , Mastrobuono F. , Pilotti L. , Ciccozzi A. , Guetti C.
Published: January 2017

Hereditary angioedema type I (HAE-C1-INH) is an inherited disorder characterized by repeated severe angioedema attacks mostly triggered by traumas, emotional stress, increased estrogen levels or surgical procedures, in particular, odontostomatological interventions. Icatibant, a bradykinin B2 receptor antagonist, has been approved for treatment of HAE attacks. In this paper we describe the “off label” administration of icatibant as short-term prophylaxis of dental extraction in a patient with HAE with the aim of preventing perioperative angioedema attacks. The drug showed an effective and safe profile. Thus, a short-term prophylaxis of angioedema attacks in patients with HAE may be arranged on a multidisciplinary basis, according to the clinical history of each single patients.
Severe Septal Panniculitis in a Multiple Sclerosis Patient Treated with Interferon-Beta
Authors: Mazzon E. , Guarneri C. , Giacoppo S. , Rifici C. , Tchernev G. , Polimeni G. , Wollina U.
Published: January 2017

We report a memorable case of severe septal panniculitis in an MS patient following the subcutaneous administration of interferon beta-1b, manifesting as a painful, indurated, erythematous lesion of the thigh, which appeared at the injection site.
Effects of Glucosamine and Nucleotide Association on Fibroblast: Extracellular Matrix Gene Expression
Authors: Avantaggiato A. , Palmieri A. , Carinci F. , Trapella G. , Sollazzo V. , Lauritano D.
Published: January 2017

Glucosamine (Gluc) is a drug used as an anti-inflammatory in moderate forms of knee arthrosis. A further off label use of Gluc is in the anti-aging treatments associated with Polideoxirybonucleotide (PDRN) through intra-dermal injection for a procedure called bio-stimulation. An unexpected effect on cultured dermal fibroblasts, during an experimental study on the gene activation in aesthetic bio-stimulation, was observed. The results have potential application in orthopaedic medical therapy. Fibroblast primary cultures were carried out, seeding cells on a layer of Gluc or PDRN alone or in combination for 24 h. Real Time-PCR was performed to investigate several gene expressions. The MMP13 and the IGF-I gene expression in fibroblast cultures were strongly inhibited after 24 h of incubation with the association of Gluc and PDRN, whereas Gluc and PDRN alone produced a modest inhibition of IGF-I and an activation of MMP13. MMP13 is present in osteoarthritic cartilage and this enzyme plays a significant role in cartilage collagen degradation. IGF1 is involved in growth and development and is successfully used in tissue-engineering for cartilage repair. Based on the reported data, we infer that the association of Gluc and PDRN has a potential application in cartilage therapy. Additional basic science and clinical studies are needed to confirm this preliminary report.
Phagocytosis of Plasmodium Berghei — Infected Erythrocytes by Mouse Peritoneal Macrophages in vitro: A Model for Screening Immunomodulating Agents
Authors: Hüther Andrea M. , Kuhnke Irmgard , Parnham M. J.
Published: January 2017

A short term in vitro screening model has been developed for immunomodulating and other agents influencing phagocytosis using serum-opsonized, Plasmodium berghei-infected erythrocytes and mouse Corynebacterium parvum-activated peritoneal macrophages. To measure phagocytic uptake a radiochemical method was applied using 3H-methionine labelled P. berghei and the precision of this method was checked by light microscopy. The infected erythrocytes did not induce an oxidative burst in the macrophages. The effects of different substances i.e. immunomodulators, scavengers of reactive oxygen species, antimalarials and antibiotics were observed and compared with their effects in other phagocytosis models. Inhibitors included muramyl peptides, 4-hydroperoxycyclophosphamide, ebselen, catalase and doxycycline.
Airway Epithelial Cells in Various Models of Bronchial Allergic Inflammation in Guinea Pigs
Authors: Tarayre J.P. , Aliaga M. , Barbara M. , Malfetes N. , Vieu S.
Published: January 2017

The number of airway epithelial cells (AEC) in bronchus lumen after various types of anaphylactic shock of similar intensity was determined in guinea pigs. Aerosol-induced anaphylactic shocks were studied after four types of active sensitization: sensitization by IM injection of 30 mg/kg ovalbumin mixed with Freund's complete adjuvant; sensitization by IM injection of 30 mg/kg ovalbumin; sensitization by IP injection of 1 μg ovalbumin and 50 mg A1 (OH)3 by animal; sensitization by 2 exposures to 1%-ovalbumin aerosol at a 7-day interval. One, 3,6,24 and 48 h after the anaphylactic reaction the number of AEC in bronchoalveolar lavage fluid (BALF) was counted in comparison to guinea pigs sensitized but exposed to 0.9% NaCl aerosol. The number of AEC was significantly increased only 24–48 h after the shock in animals sensitized with ovalbumin in Freund's complete adjuvant. In animals passively sensitized by antiserum obtained with sensitization by ovalbumin in Freund's complete adjuvant and challenged by IV or aerosol administration of antigen, non rise in the number of AEC was obtained 24–48 h after the shock. The higher amount of AEC 24–48 h after the anaphylactic reaction in animals actively sensitized by ovalbumin in Freund's complete adjuvant could be related to the higher increase in the number of neutrophils and of mononuclears obtained in the BALF at these times in comparison to other types of active sensitization. The rise in the number of AEC only after the active reaction seems to show the part played by T-lymphocytes in the induction of this effect. The increase in the number of eosinophils in BALF and the appearance of the hyperreactivity cannot be related to the rise in the AEC in bronchus lumen.
Effect of Vinpocetine on Rat Adjuvant Arthritis
Authors: Prokopová A. , Rovenský J. , Machová J. , Stančíková M. , Orviský E. , Kéry V.
Published: January 2017

The effects of vinpocetine (VP), a proposed modulator of production of arachidonic acid metabolites, on disease development and immune functions in rats with adjuvant-induced arthritis (AA) were investigated. Daily i.p. administration of VP (25 mg/kg/for 14 days) to rats with adjuvant-induced arthritis significantly reduced both edema and bone erosion in the hindpaws. After the administration of vinpocetine a decrease of serum hyaluronic acid levels, active lymphocyte number and increase of serum albumin levels were found. Decrease in urine biopterin levels were normalised after treatment with VP.

In conclusion, vinpocetine was shown to have antiinflammatory and antiarthritic effects in rats.
Modulation of the No Secretion in the Pichilan-Activated Murine Macrophage Cell Line, Malu
Authors: Vallot N. , Boudard F. , Bastide M.
Published: January 2017

The mechanism of action of pichilan, a (1->3)-β-D-glucan on nitric oxide production by a murine macrophage cell line, MALU cells, was examined. Different metabolic pathways were investigated in order to understand pichilan-induced NO secretion. We demonstrate in the present paper that neither the acid arachidonic metabolism, the cAMP nor Ca2+ accumulation occured in the pichilan mechanism of action on NO secretion. On the other hand, we observed that a phorbol ester, PMA, modulated the NO secretion. An inhibition of 36% of the NO secretion was observed; consequently, pichilan could regulate the NO secretion by way of the protein kinase C. Furthermore, we demonstrated that TNF production stimulated by pichilan activation induced NO secretion by MALU cells. TNF would be the main modulator of NO secretion by pichilan or LPS-activated MALU cells. Moreover, we can note that pichilan and LPS did not act similarly on nitrite secretion by MALU cells.
Tumor Cell Death Induced through the Receptor for Interleukin-2
Authors: Migliorati G. , Delfino D. V. , Nocentini G. , Nicoletti I. , Riccardi C.
Published: January 2017

We performed experiments to analyze the possible apoptotic effect of recombinant IL-2 on neoplastic cells expressing the receptor for IL-2. YAC-1 or EL/4 tumor cells, incubated in vitro with IL-2 or with monoclonal antibodies against the alfa-chain of the IL-2 receptor, underwent to apoptosis as analyzed by reduction in nuclear size, derangement in chromatin structure and DNA fragmentation in oligonucleosomal subunits. The apoptotic phenomenon was time- and dose-dependent. Inhibition of mRNA synthesis D-act or addition of IL-4 counteracted the effect of both IL-2 and anti-IL-2/r antibodies. Both rIL-2 or anti-IL-2/r mAb determined an augmentation of phosphorilation pattern as measured by western immunoblotting, and a transient augmentation of Ca++ as evaluated by a spectrophotometrical assay.

These data suggest that stimulation of IL-2 receptor may induce an active process of cell death on neoplastic cells in vitro.
III. Organizational Analysis of Deinstitutionalization in a Psychiatric Hospital
Authors: Reinharz Daniel , Contandriopoulos André-Pierre , Lesage Alain D
Published: January 2017

Background:

Few studies have been conducted of the organizational aspects that impact on the course of psychiatric deinstitutionalization.

Method

A case study was undertaken of 10 years of deinstitutionalization in a Montreal psychiatric hospital.

Results

Deinstitutionalization has forged ahead in the hospital over the past few years, although the course it has taken is not the one initially plotted by its promoters. Care management of deinstitutionalized patients remains under the control of the psychiatric hospital and its physicians. However, the patients' well-being has remained a focus of concern and does not seem to have been detrimentally affected by this development.

Conclusion

Deinstitutionalization is both a solution to the criticisms levelled at the hospital-psychiatric approach of managing persons with severe and persistent mental disorders and an extremely useful tool in the power struggle among the various stakeholders in mental health services reform. Deinstitutionalization has become unavoidable.
Duration of Pretreatment Phases in Schizophrenia: Women and Men
Authors: Cohen Robin Z , Gotowiec Andrew , Seeman Mary V
Published: January 2017

Objective:

To determine the relative duration of the prepsychotic prodrome and the period of untreated psychosis in women and men with schizophrenia.

Method

From a larger study population, we selected 27 women and 34 men treated at 1 facility. To determine the time of first behavioural change and the time of first psychotic symptoms, we administered the Interview for the Retrospective Assessment of the Onset of Schizophrenia (IRAOS). Subjects' mothers were interviewed using the same instrument. Time of first treatment was determined by hospital record.

Results

The first sign of behavioural disturbance occurred at approximately the same age in women and men. The prepsychotic prodrome was almost twice as long for women as for men. The duration of untreated psychosis did not differ between the 2 sexes. Substance abuse did not influence the observed difference between men and women in the duration of the prepsychotic phase. The interval between first behavioural sign and first treatment was, on average, 6 years for men and 9 years for women.

Conclusion

As-yet-unknown factors speed up the progression from nonspecific symptoms to psychosis in men or delay it in women.
Problem and Probable Pathological Gambling: Considerations from a Community Survey
Authors: Cox Brian J , Kwong Julia , Michaud Valerie , Enns Murray W
Published: January 2017

Objective:

To investigate the nature and extent of gambling problems in a region of Canada in which legalized gambling activities were expanded during the 1990s.

Method

A standardized telephone interview was conducted with a random sample of 738 community-dwelling adults (response rate 74%) in Winnipeg, Manitoba.

Results

According to traditional classification criteria, the lifetime prevalence of “probable pathological gambling” was 2.6%. A further 3.0% of the sample met criteria for traditionally defined “problem gambling,” and evidence suggests that both types of gamblers share several characteristics. Social or recreational gamblers significantly differed on several variables from individuals who reported gambling problems.

Conclusions

The 2.6% prevalence figure is the highest yet reported in a Canadian epidemiological survey and was obtained in a region that developed a more liberal attitude toward gambling in the 1990s. Further, a continuum of severity was demonstrated by scores on the South Oaks Gambling Screen (SOGS), and a clear and consistent distinction between problem and probable pathological gambling was not apparent. Frequenting casinos and using video poker and slot machines, rather than buying lottery tickets, distinguishes problem or pathological gamblers from recreational gamblers.
The Impact of Partner Support in the Treatment of Postpartum Depression
Authors: Misri Shaila , Kostaras Xanthoula , Fox Don , Kostaras Demetra
Published: January 2017

Objective:

To determine the impact of partner support in the treatment of mothers suffering from postpartum depression (PPD).

Method

Patients underwent a comprehensive psychiatric assessment and were enrolled in the study only if they met the DSM-IV criteria for major depressive disorder with postpartum onset. Patients with PPD (n = 29) were assigned randomly to 2 treatment groups: group 1 (control group) consisted of patients only (n = 13), while group 2 (support group) consisted of patients (n = 16) and their partners. The patients in both groups were seen for 7 psychoeducational visits each. In group 2, partners participated in 4 of the 7 visits. Patients in both groups were administered a set of questionnaires that included the Edinburgh Postnatal Depression Scale (EPDS), the Kellner Symptom Questionnaire, the Dyadic Adjustment Scale (DAS), and the Parental Bonding Instrument (PBI). In addition, during visits 1 and 7, all patients underwent assessment using the Mini International Neuropsychiatric Instrument (MINI), section A (major depressive episode). The partners in both groups completed the DAS and the General Health Questionnaire (GHQ).

Results

Relative to the control-group patients, the support-group patients displayed a significant decrease in depressive symptoms and other psychiatric conditions. Relative to the support group, the general health of the partners in the control group deteriorated.

Conclusion

Partner support has a measurable effect on women experiencing PPD.
The Clarke Institute Experience with Completed Suicide: 1966 to 1997
Authors: Martin Barry A
Published: January 2017

Objectives:

To describe the caseload of completed suicides at a single psychiatric facility and to review the perceived deficiencies in the care of those patients.

Method

Demographic and diagnostic data, clinical circumstances, and the deficiencies in care and documentation or both were extracted from medical records and post-suicide audit reports.

Results

There were 276 completed suicides over the period reviewed, yielding suicide rates of 206 per 100 000 registered patients and 123.5 per 100 000 inpatient discharges. The male to female ratio was 2:1, and patients with schizophrenia or depression accounted for 63.7% of the caseload. Only 18% of inpatients were involuntary, and only 10% were under individual observation at the time of suicide. Individual psychiatrists had up to 15 suicides in their caseloads. Deficiencies and recommendations pursuant to case audits are summarized.

Conclusion

This is the first report of the entire cumulative experience with completed suicide, including audited deficiencies in the care and documentation of that caseload, at a single Canadian psychiatric facility.
Training Residents for Community Psychiatric Practice: The Resident Perspective
Authors: Freeland Alison , Levine Sharon , Johnston Mary , Busby Keith
Published: January 2017

Objective:

To capture the views and experiences of psychiatry residents in 5 Canadian training programs with respect to community psychiatric training.

Method

We sent a questionnaire regarding respondent demography, career interests, and community psychiatry training experiences to psychiatry residents at 5 training programs in Ontario. We undertook descriptive analyses and frequency comparisons on the returned data.

Results

The overall response rate was 48%, with considerable variation between programs. With respect to career planning, respondents indicated highest interest in urban hospital-based practice. An interest in additional community psychiatry training was, however, expressed, particularly by junior residents. Residents' suggestions for improving community psychiatry training included better promotion of training opportunities, improved quality of supervision in community settings, and more didactic teaching.

Conclusion

Psychiatry residents are obtaining training experiences in community psychiatry, but objectives and guidelines are quite variable, as is reflected in their understanding of the definition of “community psychiatry.” Residents' career paths are still focused on urban hospital-based practice or solo private practice, which likely reflects their prevalent training experiences. There is, however, interest in community psychiatry training. Junior residents may be more open to this type of practice, and curricula should allow more exposure to community psychiatry at this stage of training.
Clinical Suggestions for Management of Stimulant Treatment in Adolescents
Authors: Weiss Margaret , Jain Umesh , Garland Jane
Published: January 2017

Children with attention-deficit hyperactivity disorder (ADHD) do not typically outgrow this condition in adolescence, which is a challenging period of development. Management of ADHD in adolescence requires specific accommodations. These include providing adolescents with as much control over treatment as possible, so that they perceive treatment to be widening their autonomy rather than limiting it. Wherever possible, medication needs to be long-acting to facilitate compliance and to minimize problems with rebound misbehaviour and moodiness. Comorbid psychiatric symptoms and syndromes need to be evaluated carefully both pre- and posttreatment. Ongoing psychoeducation and support can help to restructure the demands that an adolescent with ADHD faces at home and school so that they are more manageable. With active treatment it may be possible to prevent the serious morbidity associated with ADHD during this period and to lay a foundation for adulthood.
The Effects of Antidepressants on Sleep in Patients with Depression
Authors: Armitage Roseanne
Published: January 2017

This paper reviews sleep disturbances in patients with major depressive disorders and the effects of different classes of antidepressants on sleep. It is clear from the studies reviewed that not all antidepressants improve sleep, and, indeed, some worsen sleep disturbances in patients with depression. Whether sleep is improved or further disrupted is of high clinical significance, because persistent sleep problems elevate the risk of relapse, recurrence, or suicide, as well as the need for augmenting medications.
The Canadian Criminal Code Provisions for Mentally Disordered Offenders: A Survey of Experiences, Attitudes, and Knowledge
Authors: Crisanti Annette S , Arboleda-Florez Julio , Stuart Heather
Published: January 2017

Objective:

To systematically survey Alberta psychiatrists and lawyers regarding their knowledge of, attitudes toward, and experiences with the Criminal Code provisions regarding mentally disordered offenders to better understand the lack of impact in practice patterns.

Method

A survey design was used, and 2 questionnaires, 1 for lawyers and 1 for psychiatrists, were developed and mailed out.

Results

Out of 245 surveys sent to psychiatrists, 141 were returned, giving a response rate of 57%. The number of lawyers practising criminal law could not be determined, and 52 73 surveys were sent to all lawyers on the Law Society of Alberta mailing list. Of these, 564 were returned, giving an overall response rate of 11%. The response rate for lawyers practising criminal law is unknown. Overall, lawyers were younger than psychiatrists. Most of the respondents in both groups were men. Overall, attitudes toward offenders with mental illness were very similar among lawyers and psychiatrists. Compared with lawyers, psychiatrists had significantly more correct responses to the items assessing knowledge. With a highest possible knowledge score of 27, the average score was 16 (SD 5.7) for psychiatrists and 13 (SD 7.23) for lawyers.

Conclusions

The lack of familiarity with many of the key provisions among psychiatrists and lawyers is worrisome and suggests the need for educational materials to improve knowledge of the Criminal Code provisions governing mentally disordered offenders.
Genetic Insights into Schizophrenia
Authors: Bassett Anne S , Chow Eva WC , Waterworth Dawn M , Brzustowicz Linda
Published: January 2017

Objective:

To outline new insights into the genetic etiology of schizophrenia.

Methods:

We discuss several commonly held beliefs about the genetic issues in schizophrenia.

Results:

The complex genetic nature of the illness poses a challenge for investigators seeking causative genetic mutations. Multiple independent research findings are, however converging to identify a relatively small number of chromosomal locations that appear to contain schizophrenia susceptibility genes. Also, a clinically relevant genetic subtype of schizophrenia (22qDS) has been identified. We are developing a better understanding of how schizophrenia relates to other psychiatric disorders. While investigations into the possible roles of dopaminergic and serotonergic systems continue, other approaches that do not require theories of the mechanism of illness are also being used to identify candidate susceptibility genes.

Conclusions:

Research to date suggests that our understanding of the pathophysiology of schizophrenia will soon be fundamentally altered by genetic approaches to this complex disease.
Global Assessment of Functioning following Assertive Community Treatment in Edmonton, Alberta: A Longitudinal Study
Authors: Tibbo Philip , Joffe Ken , Chue Pierre , Metelitsa Andrei , Wright Evelyn
Published: January 2017

Objective:

To examine longitudinally the effects of Assertive Community Treatment (ACT) on Global Assessment of Functioning (GAF) scores in Edmonton, Alberta.

Methods:

We acquired GAF scores for all clients at initial registration in the ACT program and at subsequent 18- and 36-month time points while in ACT. We analyzed both the entire ACT cohort and separate diagnostic groups.

Results:

We obtained baseline and follow-up GAF scores for 411 clients, of whom the largest diagnostic group suffered from schizophrenia (n = 189), followed by bipolar disorder (n = 98). Collapsed across all groups, GAF scores significantly improved at both 18 (P < 0.0001) and 36 months (P < 0.0001). By group, at 18-month follow-up, significant improvements were seen in patients with delusional disorder (P < 0.05), dysthymia (P < 0.05), schizoaffective disorder (P < 0.05), and schizophrenia (P < 0.001). This was also seen at 36-month follow-up, with the addition of significant improvements in those with bipolar disorder (P < 0.05). Those patients with major affective disorder or psychosis not otherwise specified (NOS) did not show significant improvements over time. Regardless of diagnosis, those clients with baseline GAF scores of ≤ 40 significantly improved at both 18-month (P < 0.0001) and 36-month (P < 0.0001) follow-up, while those with baseline GAF scores above 40 did not show significant improvement.

Conclusions:

GAF scores improved at 18- and 36-month follow-up from enrolment in an ACT program. Groups with different diagnoses and levels of functioning at time of enrolment may not benefit to the same degree.
Delirium in Psychiatric Inpatients: A Case-Control Study
Authors: Patten Scott B , Williams Jeanne VA , Petcu Ruxandra , Oldfield Robin
Published: January 2017

Objective:

To investigate the clinical and pharmacoepidemiological determinants of delirium in a psychiatric inpatient population.

Method:

A case-control study design was used. Potential cases and potential controls were identified using hospital discharge data. The clinical record of each subject was reviewed using a validated protocol to confirm case and control status. Subsequently, exposure data were recorded from clinical records.

Results:

Subjects admitted to hospital with delirium tended to be older, to have pre-existing cognitive deficits, and to have diagnoses of substance use disorders. Subjects who developed delirium after their admission to hospital were older than control subjects, more likely to have a history of cognitive impairment, and were significantly more likely to be treated during the hospitalization with lithium or anticholinergic antiparkinsonian medications. Antipsychotic medication exposures were also associated with delirium, but only at standard or above-standard dosage levels. Antidepressant and sedative-hypnotic medications were not associated with delirium.

Conclusions:

These findings indicate that using conservative dosages of antipsychotic medications and minimizing the use of anticholinergic medications for parkinsonian symptoms may help to prevent delirium in psychiatric inpatients. Anticonvulsant mood stabilizers may convey less delirium risk than lithium. Antidepressant medications and sedative-hypnotics were not important determinants of delirium in this population.
Psychological Treatments for Anorexia Nervosa: A Review of Published Studies and Promising New Directions
Authors: Kaplan Allan S
Published: January 2017

Objective:

To review the existing literature on the psychological treatments for anorexia nervosa (AN), especially randomized clinical trials that have been published. In addition, new psychological approaches will be described.

Method:

An extensive literature review was conducted to identify the psychological treatment trials on AN that have been published over the past 3 decades.

Results:

Fewer than 20 controlled clinical trials were identified, evaluating the effectiveness of various types of psychotherapy in AN treatment. Evidence for the effectiveness of these interventions, with the exception of family therapy for younger patients with shorter duration of illness, remains questionable. Promising new approaches include motivational enhancement therapy and psychotherapies aimed at relapse prevention.

Conclusion:

Currently, there is little empirical evidence on which to base treatment decisions regarding the psychological treatments for AN. There is a desperate need for further research in this area, especially examining relapse prevention and motivational enhancement strategies for AN.
Acute Psychiatric Inpatient Care for People with a Dual Diagnosis: Patient Profiles and Lengths of Stay
Authors: Burge Philip , Ouellette-Kuntz Hélène , Saeed Haider , McCreary Bruce , Paquette Dana , Sim Franklin
Published: January 2017

Objective:

This study describes characteristics of psychiatry inpatients with developmental disabilities (DD) and their admissions to psychiatry wards in 2 acute care hospitals. It also compares differences in lengths of stay between admissions of this group with a comparison sample of inpatient admissions without DD.

Method:

A retrospective chart review was conducted on all individuals with DD who were psychiatric inpatients at 2 Kingston, Ontario, general hospitals, within a 4-year period (1994 to 1998). A comparison sample of admissions of patients without DD was chosen. Frequency tables were used to describe the inpatients with DD and to describe the 2 samples of admissions. Nonparametric statistics were used to compare the median length of stay between the 2 samples. Associations between length of stay and other covariates were explored within the sample of patient admissions with DD.

Results:

The 62 individuals with DD had 101 admissions over the study period. Suicidal ideation was the most common admission reason (46%), and mood disorder was the most common discharge diagnosis (29%). The median length of stay for patients with DD was 8 days, which did not differ meaningfully from the comparison sample. Variables that were significantly associated with length of stay among individuals with DD included sex, referral source, and diagnosis.

Conclusion:

When individuals with DD are psychiatric inpatients, their length of stay is affected by some factors that have been identified in previous studies not specific to DD (for example, referral source and diagnosis). Our finding that male patients with DD have longer lengths of stay than do female patients in the same sample has not been reported in previous research.
Topiramate Use in Obese Patients with Binge Eating Disorder: An Open Study
Authors: Appolinario Jose C , Fontenelle Leonardo F , Papelbaum Marcelo , Bueno João R , Coutinho Walmir
Published: January 2017

Objective:

To assess topiramate's efficacy and tolerability in a group of obese binge eaters with no neuropsychiatric comorbidity.

Method:

We consecutively selected 8 obese patients with binge eating disorder (BED) and no medical or psychiatric comorbidity from individuals seeking treatment for obesity. Treatment with topiramate at 150 mg daily was administered over a 16-week period. To assesss outcome, we employed the days with binge episodes per week (DBE), the Binge Eating Scale (BES), the Beck Depression Inventory (BDI), and body weight evaluation.

Results:

Of the 6 patients who completed the trial, all showed reduced binge eating. Four patients presented a total remission, and 2 had a marked reduction in binge eating frequency. The mean DBE decreased significantly from 4.3 to 1.1 ( P = 0.03), as did the BES scores, which fell from 31.8 to 15.3 ( P = 0.04). Moreover, there was a statistically significant weight loss (mean 4.1 kg, P = 0.04). The most frequent side effects were paresthesias, fatigue, and somnolence.

Conclusion:

Topiramate may be an effective and well-tolerated agent in the treatment of BED in obese patients.
Barometric Pressure, Emergency Psychiatric Visits, and Violent Acts
Authors: Schory Thomas J , Piecznski Natasha , Nair Sunil , El-Mallakh Rif S
Published: January 2017

Background:

Associations between human behaviour and psychiatric decompensation and weather variables have been inconsistent.

Objectives:

We studied the association of certain weather variables (specifically, humidity, wind speed, and barometric pressure) with emergent psychiatric presentations, psychiatric admissions, incidence of violent crimes, and suicides in a metropolitan area.

Method:

We performed a retrospective study for the year 1999 in a mid-sized city. We included all documented emergent psychiatric visits to the city's psychiatric emergency room. We obtained violence data from the city police department and suicide data from the county medical examiner.

Results:

The data suggest that total numbers of acts of violence and emergency psychiatry visits are significantly associated with low barometric pressure. Psychiatric inpatient admissions and suicides are not associated with any of the weather variables investigated.

Conclusions:

While alternate conclusions can be drawn, we propose that the data support the interpretation that low barometric pressure is associated with an increase in impulsive behaviours. Additional investigation is warranted.