bluuebunny/crossref_metadata_2025 huggingface dataset:
Procurations and the English Church
Authors: Smith Peter M.
Published: August 2016

The procuratio was originally the hospitality necessarily provided for an ecclesiastical ordinary and his retinue when engaged in a visitation of the churches and spiritual places of his jurisdiction: ‘per procurationes … intelligitur necessariorum sumptuum exhibitio, que ratione visitationis debetur. …’ By this means the provision of food, drink, and accommodation for the visitor as he perambulated his territory was placed on a formal footing, so that most of the expenses of visitation might be met, and the visitor with his attendants assured of somewhere to spend each night in reasonable comfort.
Notoriety: A Mediaeval Change of Attitude
Authors: Evans G. R.
Published: August 2016

Scripture refers to an ‘informer’ in the story of the rich man who had a steward, and was told that he was mismanaging his master's resources (Luke 16: 1ff). The Vulgate has hic diffamatus est apud ilium. We hear nothing more about the informer in this parable, or what became of him. He is not reproached for his action.
‘The Letter Killeth, But The Spirit Giveth Life’ (2 Cor 3:6)
Authors: Hope David
Published: August 2016

I begin this evening with a text rather than a title, though I hope my presentation will be more in the nature of an address than a sermon. And I select this text because I believe it focuses very well and very sharply the sort of concerns which you are to address in your conference over this weekend—Practical Parish Problems: Gospel and Order. For how often have I heard this text trotted out in defence of the people getting on and doing what they want to do without reference to all those interfering lawyers who in any case cost a great deal of money! We are perfectly capable of ordering our own affairs thank you very much they say; why this dead hand of the law as it is perceived, which so often apparently stifles the inspiration and the initiative of the spirit?
Losing One's Faculties
Authors: Hill Mark
Published: August 2016

Two main functions are performed by the consistory court. The first is the discipline of clergy which is presently the subject of a wholesale review by General Synod following the recommendations of the Hawker Report and has been the subject of much comment, not least in the pages of this Journal. At the time of writing, a draft Measure is still awaited. The second main function is the exercise of the faculty jurisdiction in relation to church buildings, their contents and their surroundings. Central to the effective exercise of this jurisdiction is the ecclesiastical exemption—a pragmatic ‘stand-off’ between central government and certain Christian denominations whereby listed church buildings are not subject to the secular sytem of listed building consent or conservation area control by local authorities. This too has been the subject of recent review. The purpose of this paper is to examine the role of the consistory court in faculty matters and to contribute to the debate which the Newman Report will doubtless engender. The views expressed are, of course, my own and not those of the Ecclesiastical Law Society or any other body.
Ex Africa Semper Aliquid Novi: Colenso Revisited
Authors: Jones Thughie
Published: August 2016

This paper had its origin in anexcursusto the dissertation offered in part requirement for the University of Wales LLM degree in Ecclesiastical and Canon Law. Like all work on Colenso, it is indebted to the magisterial investigations of the late Peter Hinchliff, in whose biography of Colenso will be found an extensive bibliography to 1964. Later sources are itemised in this paper.
The Disestablishment of the Church in Wales
Authors: Brown Roger L.
Published: August 2016

During the earlier part of 1993 a paper of mine was published in the Ecclesiastical Law Journal. Entitled ‘What of the Church in Wales?’, it endeavoured to suggest why the disestablished Church in Wales still maintained the characteristics of an established Church. The paper seems to have aroused much interest within certain circles of the Church of England, especially among synod members, at a time when the question of disestablishment was once more being publicly aired. The point was made to me repeatedly that disestablishment would need to be accompanied by dis-endowment, although the only reason for this assertion appears to have been the historical precedents of the Irish and Welsh disestablishments. I am not competent to write about the former, but with regard to the latter I feel that a historical examination of the events which led to the disestablishment of the Church in Wales might raise some question marks against this assertion.
The Beginning of Life
Authors: Harries Richard
Published: August 2016

There are a number of ethical issues connecting with the beginning of life, most obviously abortion and most recently research on embryos. These issues have a number of aspects, particularly in relation to fertility treatment and genetic manipulation but they all assume answers to prior questions about what it is to be a human being and when it is that an entity, to use a neutral term, is accorded the full protection due to a human person. So it is that in this first lecture I will be concentrating on souls, persons and embryos.
The Impact for the Church of England of the Human Rights Act 1998
Authors: Hill Mark
Published: August 2016

Though the first nation state of the Council of Europe to ratify the European Convention on Human Rights on 18th March 1951, and though permitting individual petition to the European Court in Strasbourg since 1966, the United Kingdom declined to give effect to the Convention in its domestic law until the government recently passed the Human Rights Act 1998. The Act received the Royal Assent in November 1998 and will come into force on 2nd October 2000.
Welsh Church Courts and the Rule of Law
Authors: Watkin Thomas Glyn
Published: August 2016

‘As from the date of disestablishment ecclesiastical courts and persons in Wales and Monmouthshire shall cease to exercise any jurisdiction, and the ecclesiastical law of the Church in Wales shall cease to exist as law.’
The Patronage (Benefices) Measure 1986 An Analysis of its Working in Practice
Authors: Parrott David
Published: August 2016

In an article in this Journal recently Peter Smith set out the history of what he called a most peculiar property, the advowson. He finished by mentioning the introduction of the current legislation, the Patronage (Benefices) Measure 1986. This article seeks to take up where he finished by reviewing the practice of appointments under the 1986 Measure, and considering some of the lessons of the last few years. I shall also argue that the time is right to review the Patronage (Benefices) Measure Code of Practice, in the light of some of the legal issues I highlight.
Goring Revisited: George Bell, The Artist Hans Feibusch, and Art in Church
Authors: Foster Paul
Published: August 2016

There is adventure about—both at home and abroad. More especially, events are taking place in respect to the place of visual art in the witness of the Church that a generation ago, or even less, would have been laughed out of court: for the counsel of this committee or that, whether at parish vestry or cathedral chapter, would have looked askance at what, today, seems to be accepted almost on the nod. Examples of what is occurring, and especially in cathedrals up and down the country, are easy to cite. One need think only of recent exhibitions at Salisbury; the use of video (Bill Viola'sThe Messenger)at Durham; the appointment of an artist in residence at Gloucester;Sculpture for Winchester, the 1998 exhibition arranged in part across the Inner Close of the cathedral; an exhibition in November 1999 of Sussex artists in the North Transept at Chichester, conducted with a view to raising funds for the continuing restoration of the cathedral; Anthony Green'sResurrection, An Act of Faithat Christ Church, Oxford; or the planned (at the moment of writing) millennial exhibition,Stations, the New Sacred Art, to be held in 2000 both at the cathedral in Bury St Edmunds and at twelve associated parishes. Varied as these examples are, they all share a very distinct characteristic—the temporary nature of the arrangements, for which no formal permission or approval was legally required from any supererogatory body or bodies. Reasons for this development are complex, and the outcomes— which frequently create controversy—are often fiercely debated. What has received less attention, however, is the foundation of the present relationship between art and the Church, a relationship that can be seen to stretch back to a judgment made by George Bell, then Bishop of Chichester, in his own consistory court in 1954, concerning a design for a mural by Hans Feibusch in the parish church at Goring-by-Sea.
Dignity At Work
Authors: Trott Stephen
Published: August 2016

I have been privileged in recent years to be able to see the work of national church institutions from the perspective not only of a General Synod member, but also as a member of a modern trade union, which came into being in August 1994. It is one thing to be concerned with the role, status and conditions of service of the clergy, as a parish priest and as a member of a professional union—it is quite another to be made aware of the implications of change as they are viewed centrally, not the least of these being the cost of improved conditions of service.
Living in Suspense Problems and Solutions with Suspension of the Right of Presentation
Authors: Harris Jonathan Redvers
Published: August 2016

To those familiar with the practice of suspension of the right of presentation this theme may be a sensitive one, arousing perhaps fierce passions. To those unfamiliar it may simply sound like a technical abstraction. I hope that the former, out of consideration for the latter, will allow me the indulgence of setting the scene for this subject by drawing upon the true circumstances of one benefice in a diocese in the southern Province.
Working Party on ‘Disestablishment’ Report
Authors: Spafford George , Brown Roger L , Nicholls Ben
Published: August 2016

The working party was set up in 1991, and has met on a number of occasions since then at various venues. It became clear that because of other commitments its members felt unable to make a thorough study of the subject, and it was decided to produce a working paper which would set out the points which would need to be addressed if a Bill to disestablish the Church of England was ever introduced. The working party is now dissolved, though there is still need for another group to forward the discussion at a time when the concept of ‘re-establishment’ is gaining favour. The members of this working party, it should be stressed, were themselves divided about the need, or otherwise, of disestablishment. Equally, members of the working party were drawn from the established Church of England and the disestablished Church in Wales. We also had some input from members living abroad.
Christian Doctrine and Judicial Review: The Free Church Case Revisited
Authors: Cranmer Frank
Published: August 2016

In the latter part of the nineteenth century there were attempts to unite the various bodies which had split off from the Church of Scotland in the previous hundred years. In particular, there were great hopes for a union between the United Presbyterian Church [UPC] and the Free Church of Scotland [FC].
Changing Approaches to the Bishopsgate Questions
Authors: Adam Will
Published: August 2016

A glance at the Case Notes section of the Ecclesiastical Law Journal over the last few years points the reader to a flurry of activity in alteration of listed church buildings. This is spurred on by (among other things) changing views and practice of liturgy, access for the disabled, repair of damaged buildings. replacement of worn fabric, making a building multi-purpose, comfort and audibility in worship, the incorporation of new technology, providing space for hospitality, accommodating children's work and commemorating the turn of the Millennium. Chancellors have had to strike a delicate balance between two opposing and contradictory points of view. On the one hand the view of some petitioners that ‘any alteration which is seen by the incumbent and congregation to be desirable in order to encourage and assist true worship should be permitted without outside restraint’. On the other hand the view of the heritage lobby and others that ‘most of the churches in this land are national treasures of which the present incumbent and the present congregation are merely temporary occupiers and custodians with no right to make unnecessary or, as some would seem to argue, any alterations’. Whilst the ecclesiastical courts have at times placed a restraining hand on those seeking to alter church buildings, there is ‘no requirement in law either that a church should be maintained for all time in the state in which it happens to be at present, or that it should automatically be changed in accordance with the latest liturgical fashion’.
The Changing Legal Framework of Establishment
Authors: McClean David
Published: August 2016

This article looks closely at the legal nature of Establishment, both in England and North of the Border. The legal material shows that the two cases are very different. The Ace od Supermacy 1558 and related legislation enable the English church's porition to be presented so as to meke it one aspect of the State, and tetwntieth-century case-law has tended to confirm that understanding. The Scottish kirk enjoys statutory autonomy under the Church of Scotland Act 1921, and again case-law emphasises the reality of its exemption from some of the usual jurisdiction of the secular authorities and courts (though its scope may be becoming less clear-cut in the light of developments within the European Community). The author asks how, in the English context, the legal analysis relates to the reality of the English situation, as seen through the insights of other disciplines, to the role of the Church of England nationally and locally, and to the, sometimes confrontational, relationship between Synod and Parliament.
The Consequences of Aston Cantlow
Authors: Nugee Edward
Published: August 2016

The two main aspects of the Aston Cantlow case1 have been the subject of considerable academic interest.2 The first concerns the status of a parochial church council (‘PCC’) for the purposes of the Human Rights Act 1998, and by implication the status of many other church bodies under that Act. The second concerns the law relating to the liability of certain individuals and corporate bodies to repair the chancel of the parish church.
England's Last Bachelors and Doctors of Canon Law
Authors: Barber Paul
Published: August 2016

The editorial of this Journal recently recorded that an English university had awarded degrees in Canon Law for the first time in nearly 500 years.1 That event sparked this short piece of research to discover the identity of the last graduates. To begin our short story, imagine, if you will, the scene on a summer's day in 1535.
Human Rights and Human Remains: the Impact of Dödsbo v Sweden
Authors: Sandberg Russell
Published: August 2016

The legal revolution brought about by the Human Rights Act 1998 has affected arcane legal areas such as the law of exhumation, by questioning whether refusal to grant an application to exhume and move a dead body would breach the applicant's human rights under the European Convention on Human Rights (ECHR). While the Consistory Courts have been quick to develop arguments based on human rights, the majority of the European Court of Human Rights in its recent judgment in Dödsbo v Sweden showed a greater reluctance to do so, emphasising the fact that although the refusal to exhume may interfere with the applicant's human rights, such an interference could be valid under the terms of the ECHR.
To Equality and Beyond: Religious Discrimination and the Equality Act 2006
Authors: Sandberg Russell
Published: August 2016

Recent years have witnessed a piecemeal development of discrimination law that affects religious organisations: the collection includes statutes such as the Sex Discrimination Act 1975 and the Race Relations Act 1976, statutory instruments such as the Employment Equality Regulations 2003 and 2005, and international human rights instruments such as Article 14 of the European Convention on Human Rights (ECHR). The newest addition to the collection is the Equality Act 2006 (c 3), which received Royal Assent on 16 February 2006.
Mediation in Faculty Applications
Authors: King Richard
Published: August 2016

Mediation is becoming widely used as an alternative means of resolving disputes that have hitherto been decided in court or by arbitration. Mediation typically involves the appointment of a third party neutral who works with the parties to explore with them how they can consensually resolve their dispute. Hallmarks of the process are (1) confidentiality, both in relation to communications between the mediator and each party and in relation to the judge or arbitrator who will hear the case if mediation is unsuccessful, and (2) the mediator's role as a facilitator of a negotiated agreement rather than an evaluator of the likely prospects of success of the parties.
The Genetics of Tourette Syndrome
Authors: Alsobrook John P.
Published: August 2016

The familial nature of Tourette syndrome (TS) was first described by Georges Gilles de la Tourette in 1885. Formal investigations of TS since the 1970s have consistently demonstrated an increased risk for TS among relatives of patients with TS. Family studies, twin studies, and segregation analyses all indicate that TS has significant genetic determinants. The mode of transmission, while mildly controversial, is generally believed to be due to at least one major locus inherited either as an autosomal dominant trait with reduced penetrance, or as a trait with intermediate inheritance in which some heterozygotic persons manifest the disorder. There is evidence for a TS spectrum of symptoms that includes chronic tics and obsessive-compulsive disorder. Systematic genome linkage studies of TS are progressing. To date, however, no significant linkage findings exist, although the search has included many neurologically relevant candidate genes.
Diagnosis and Management of the Psychosis, Intermittent Hyponatremia, and Polydipsia Syndrome in Psychiatry
Authors: Greenfield Daniel P.
Published: August 2016

The psychosis, intermittent hyponatremia, and polydipsia (PIP) syndrome is a prevalent, medically serious, and difficult to treat condition in psychiatry, especially common in hospitalized chronic schizophrenic patients. In this paper, the pathophysiology and clinical manifestations of the PIP syndrome are presented as an overview, and a program of medical/pharmacologic, nursing, behavioral, and psychiatric/psychological interventions is presented and discussed. The emphasis throughout this paper is on multidisciplinary treatment approaches for patients with PIP syndrome, including medical, psychiatric, psychosocial, behavioral, and nursing contributions to the evaluation and care of these often difficult patients.
Augmentation Strategies in the Treatment of Schizophrenia
Authors: Goff Donald C. , Freudenreich Oliver , Evins A. Eden
Published: August 2016

Use of augmenting agents in schizophrenia is a common practice in response to resistant symptoms or comorbid illness. Increasingly, clinicians are combining more than one antipsychotic agent, despite a lack of evidence from controlled studies to support this approach. A rationale can be made for adding higher-potency agents to clozapine in an attempt to optimize D2dopamine receptor blockade, but this strategy requires further study before it should be adopted in clinical practice. Older reports have explored the use of antidepressants, mood stabilizers, and anxiolytics as augmenting agents. These agents appear to improve comorbid affective or anxiety symptoms, but earlier evidence of improvement in psychotic or negative symptoms has not been replicated consistently. Glutamatergic agents acting at the glycine coagonist site of the N-methyl-D-aspartate receptor, including glycine, D-cycloserine, and D-serine, have demonstrated impressive therapeutic effects for negative symptoms when added to conventional neuroleptic agents, but do not appear to enhance clozapine efficacy. Given the high rates of symptom persistence and disability associated with schizophrenia, the need for augmentation strategies is great, but no approach has clearly emerged as effective for a substantial portion of patients. Although certain approaches may prove helpful for individual patients, augmentation should not be used unless monotherapy has been optimized, and should not be continued long-term unless benefits are clear.
Neuropsychiatry: Now More Than Ever
Authors: Gorman Jack M.
Published: August 2016

The end of 2001 is unlike any year's end in most of our memories. On September 10, my most serious worry was the chances for my beloved New York Yankees to win their fourth consecutive pennant. The next day, and ever since, that has hardly been a blip on the radar screen of concern. For those of us interested in studying the nervous system, we must remember that the most enduring fallout of the September 11 tragedy is emotional—our population is now a frightened one. Never before has the study of the neuro-science of emotion seemed more important. In subsequent issues, we will have much more to say on this topic.

For physicians and neuroscientists alike, we must also focus on the clinical and research issues that existed before September 11 and will continue to be our responsibility. This issue of CNS Spectrums offers articles on a diversity of topics: epilepsy, genetics, and the treatment of schizophrenia.
The Truth, The Whole Truth, and Statistical Parametric Maps
Authors: Trimble Michael
Published: August 2016

Over 20 years ago, Monte Buchsbaum first presented metabolic brain images belonging to a patient with schizophrenia at the American Psychiatric Association's annual meeting. This was a truly remarkable achievement brought about by the combined skills of the deoxyglucose technique developed by Lou Sokoloff and colleagues, and the advancement of statistical algorithms for the analysis of computerized images. Positron emission tomography (PET) had arrived, but more importantly, the imaging era of neuropsychiatry was dawning. Since then, we have been treated to a glorious array of technical developments which has seen not only coregistration of functional images (ie, PET) with corresponding structure (magnetic resonance imaging [MRI]), but a proliferation of MRI techniques that allow not only temporal and spatial resolutions undreamed of two decades ago, but permit safe, repeated testing of patients, allowing for experiments of considerable sophistication to be designed.

Now, at any neuroscience meeting, many presentations are accompanied by brain images, often PETs. However, more and more often now we are seeing one form or another of MRI. Such images are displayed from various angles, adorned with multiple colors, and garnished with institutional logos, confirming (and less regularly refuting) the presenter's hypothesis about how the brain is supposed to work in relation to various cerebral functions.
Noradrenergic Pathology in Psychiatric Disorders: Postmortem Studies
Authors: Ordway Gregory A. , Klimek Violetta
Published: August 2016

In this paper, we review research utilizing postmortem brain tissue in order to investigate the potential neuropathology of the noradrenergic system in psychiatri disorders. The postmortem tissue approach to the study of the noradrenergic system has been used primarily in investigations of the biology of suicide and depression. Findings from postmortem studies provide data generally consisten with the hypothesis that a norepinephrine deficiency exist depression, and possibly in the victims of suicide. However postmortem studies do not presently provide irrefutable evidence of noradrenergic neuropathology. Technical shortcomings, issues of reproducibility, and the strengths postmortem research are reviewed. More rigorously performed postmortem research is needed to aid researchers in pinpointing specific neuropathologies associated with psychiatric disease.
Catatonic Syndrome in an Adolescent Male Immigrant: A Case Report
Authors: Panikkar Gopakumar P. , Mayerhoff David
Published: August 2016

In this article, we report a unique case of catatonic syndrome in an adolescent male. This patient did not have a primary psychiatric diagnosis before the onset of catatonia, and there was no evidence of any predisposing medical conditions. The episode occurred following the patient's immigration from his native country, an event associated with particular psychological stress. The episode was reversible and demonstrated a prompt but transient response to intravenous administration of lorazepam. Maintenance treatment included oral administration of lorazepam and risperidone. Lorazepam was tapered and eventually discontinued, and symptoms did not recur.
Self-Report and Objective Measures of ADHD-Related Behaviors in Parents of Preschool Children at Risk for ADHD
Authors: Kera Elizabeth A. Curko , Marks David J. , Berwid Olga G. , Santra Amita , Halperin Jeffrey M.
Published: August 2016

Objective: Few studies have used a combination of objective and self-report measures to examine neuropsychological and behavioral functioning in parents of children with attention-deficit/hyperactivity disorder (ADHD). This study examined attention and inhibitory control in the parents of preschool children who were rated as “at risk” for developing ADHD as compared with parents of controls.

Methods:Preschool children (N=53) were divided into at risk for ADHD and control groups based on parent and teacher ratings of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition ADHD symptoms. One parent of each child was administered an identical pairs Continuous Performance Test (CPTIP), a Go/No-Go task, and the Brown Attention-Deficit Disorder Scale for Adults.

Results: Parents of preschoolers at risk for ADHD showed a pattern of responding on measures of vigilance characterized by slower reaction times and increased commission errors as compared with parents of controls. There were no significant group differences on self-report measures on the Brown Attention-Deficit Disorder Scale for Adults.

Conclusion: Parents of preschoolers at risk for ADHD appear to exhibit cognitive processing deficits that may not be evident using self-report measures. Further research is needed to more clearly identify the specific nature of these neuropsychological deficits and to determine whether they have a negative impact on their children.
Management of Hyperprolactinemia in Patients Receiving Antipsychotics
Authors: Miller Karen K.
Published: August 2016

Hyperprolactinemia is increasingly prevalent in patients with common psychiatric disorders due to increasing prescriptions of antipsychotics, particularly newer atypical neuroleptics, in these patients. However, measurement of prolactin levels is indicated only in symptomatic patients. When hyperprolactinemia is diagnosed, work-up should include exclusion of other causes of hyperprolactinemia, particularly those that might require treatment. Once such causes have been ruled out, a minority of patients with antipsychotic medication-induced hyperprolactinemia, including those with clinically significant signs and symptoms, will require treatment. When treatment is indicated, specifically when hyperprolactinemia results in amenorrhea in women or testosterone deficiency in men, dopamine agonist therapy is generally not advisable. Hormone-replacement therapy, which involves estrogen/progestogen in women and testosterone in men, can often prevent modification and interruption of successful psychiatric medication regimens.
Mixed Amphetamine Salts Extended Release for the Treatment of ADHD
Authors: Biederman Joseph
Published: August 2016

Attention-deficit/hyperactivity disorder (ADHD) is widely recognized as one of the most common psychiatric disorders initially diagnosed and treated in childhood; however, it is less widely recognized as a disorder that often persists into adolescence and adulthood. In recent years, there has been increased awareness that adult ADHD is marked by significant impulsivity and impairments of attention and executive function, symptoms that can be linked to, personal, social, and professional dysfunction. Clinicians are increasingly recognizing adult ADHD as a disorder linked to considerable dysfunction and distress, warranting appropriate pharmacologic treatment.

Psychostimulants, such as amphetamines and methylphenidate, are recommended as first-line pharmacotherapeutic agents for the management of ADHD in children, adolescents, and adults. Because most research on psychostimulant use has involved pediatric ADHD patients, little is known about the safety and efficacy of these agents in adult ADHD.
Treatment of Obsessive-Compulsive Disorder
Authors: Stein Dan J. , Ipser Jonathan C. , Baldwin David S. , Bandelow Borwin
Published: August 2016

Background: Many randomized controlled trials of the pharmacotherapy and psychotherapy of obsessive-compulsive disorder (OCD) have been undertaken. Several meta-analyses of these trials, and a number of expert consensus guidelines, have been published. This article summarizes these works, and suggests future research directions.

Methods: Meta-analyses of OCD were assessed with the QUORUM statement and the Oxman and Guyatt rating scale, and consensus guidelines on the treatment of OCD were assessed with the Appraisal of Guidelines Research and Evaluation (AGREE) instrument. Current principles in the treatment of OCD, and gaps in our knowledge, were reviewed.

Results: Selective serotonin reuptake inhibitors (SSRIs) and cognitive-behavioral therapy are currently viewed as the first-line treatments of choice for adult and pediatric OCD.There is also good evidence for the efficacy of atypical antipsychotics in the augmentation of patients refractory to SSRIs. Important questions remain for the field.

Conclusions: There have been significant advances in both the pharmacotherapy and psychotherapy of OCD. Nevertheless, there is a paucity of longer-term trials, data on symptom remission and functional improvement, and data on treatment effectiveness in wider clinical practice. It is hoped that improved understanding of the mechanisms underlying OCD will lead to future advances.
Specificities of Treatment in Pediatric Obsessive-Compulsive Disorder
Authors: Flament Martine F. , Geller Dan , Irak Metehan , Blier Pierre
Published: August 2016

Obsessive-compulsive disorder (OCD) experienced in childhood or adolescence is often a chronic disorder with high subjective distress and impairment of family and social functioning. An early comprehensive intervention schedule can have a profound effect on outcome in later years. The clinical manifestations of OCD among children and adolescents do not seem to be inherently different from those of adult patients. In younger subjects, the clinical picture tends to be dominated by compulsions, and insight can be poor, with little recognition of the symptoms as a problem.There is often a shift in symptoms over time, with some symptoms being replaced by others, while in adults, the core obsessions and compulsions tend to be more stable. In addition to depression and anxiety disorders, the spectrum of comorbid psychopathology seen in pediatric OCD patients includes tic, disruptive behavior, and specific developmental disorders. The treatment of childhood and adolescent OCD relies on cognitive-behavioral techniques of psychotherapy and pharmacotherapeutic interventions similar to those recommended in adults. The efficacy of exposure and response prevention in pediatric OCD has been shown in numerous open studies, and four controlled trials. Pharmacotherapy relies on serotonergic medication, and all have been demonstrated to be significantly superior to placebo, as reported in a recently published meta-analysis. Current concerns with the use of SSRIs in children and adolescents were explored as regards OCD and anxiety disorders, and there is no evidence for an increase in suicide or related behaviors.
Identifying Vulnerability Markers in Prodromal Patients: A Step in the Right Direction for Schizophrenia Prevention
Authors: Knowles Lucy , Sharma Tonmoy
Published: August 2016

Research has shown that many of the long-term deficits that are observable in schizophrenia populations are present prior to the emergence of psychotic symptoms. Recent research suggests schizophrenia has a “prodromal” period, whereby significant changes from premorbid functioning can be observed. Accurate classification of this period could have far-reaching implications for schizophrenia prevention. This article aims to provide an indepth evaluation of the perceived benefits of vulnerability marker research in this unique phase. It is hoped that identification of such markers may improve the predictive potency of prodromal criteria, and perhaps pave the way for future screening and primary prevention strategies.
Premorbid Cognitive and Behavioral Functioning in Military Recruits Experiencing the First Episode of Psychosis
Authors: Gheorghe Mihai D. , Baloescu Alexandrina , Grigorescu Gabriela
Published: August 2016

Objective:

To characterize the premorbid cognitive and behavioral abilities in apparently healthy adolescents who at a later time will be diagnosed with schizophreniform disorder or schizophrenia.

Background:

Clarifying the pathological relationship between subtle intellectual and behavioral abnormalities and disease could provide markers for the early prediction of future psychosis.

Method:

Premorbid data on young male patients admitted to the Department of Psychiatry of the Central Military Hospital in Bucharest, Romania, between 1996 and 2002 and diagnosed with a first episode of psychosis or schizophreniform disorder were collected. The premorbid data consisted in the test scores of intellectual functioning and personality traits were collected by the Romanian Draft Board in order to assesses their aptitude to serve in the military. Premorbid cognitive and behavioral scores of male patients (cases=157) were compared with the scores of healthy male individuals (non-cases=169) matched for age, education, and geographic area of residence. The tests were administered when subjects were 18 years of age (initial screening) and the entire assessment was completed and concluded when subjects reached 20 years of age (actual conscription).

Results:

As a group, apparently healthy males later admitted for a first episode of psychosis or schizophreniform disorder, obtained lower (worse) scores on the Raven Progressive Matrices test and on relevant personality traits in comparison to controls.

Conclusions:

The results add to the accumulating body of evidence suggesting that aspects of schizophrenia manifest years before the illness is formally diagnosed. Despite these results, more studies are needed to improve the diagnosing specificity and predictive value of the premorbid cognitive and behavioral manifestations, before they can be used as markers in models of primary or secondary prevention.
The Urgent Need for Monitoring and Intervention to Reduce Metabolic Risk Factors in Patients with Schizophrenia
Authors: Nasrallah Henry A.
Published: August 2016

Serious mental illness is associated with a significant reduction in life expectancy of ≤30 years. Among patients with schizophrenia, mortality due to coronary heart disease is ∼50% higher than that of the general population.

Patients with schizophrenia have substantially higher rates of cardiovascular risk factors (smoking, high cholesterol, hypertension, physical inactivity, obesity/overweight, and diabetes) than the general population. Approximately 75% of individuals with schizophrenia smoke compared to ∼25% of the general population. Patients with schizophrenia also have lipid profiles that are significantly worse than those of individuals in the general population.
Impairment Associated with Adult ADHD
Authors: Stein Mark A.
Published: August 2016

Attention-deficit/hyperactivity disorder (ADHD) is present in 4% to 6% of adults in the United States. In the National Co-morbidity Survey Replication, a diagnosis of ADHD was associated with greater marital problems, unemployment, difficulties in the workplace, and frequent workplace absence. Despite these findings, the body of knowledge regarding impairment in adult ADHD is far from complete. Building upon our knowledge of impairment in adults with ADHD will result in a broader range of treatment outcomes which may be measured and targeted.
Cardiovascular Safety of ADHD Medication Treatments
Authors: Newcorn Jeffrey H.
Published: August 2016

There are several important issues regarding the manner in which medications are tested prior to their release and monitored after approval that must be appreciated in considering issues related to cardiovascular safety of medication treatments for attention-deficit/hyperactivity disorder (ADHD) in adults. First, patients treated in clinical trials are not necessarily representative of those seen in practice settings, as specific inclusion/exclusion criteria in studies limit a variety of psychiatric, medical, and social factors that could potentially introduce confounds related to the collection and/or interpretation of efficacy, tolerability, and safety data. However, many of these factors are present in patients treated in clinical practice. In addition, the manner in which medications are administered in clinical trials does not necessarily replicate the way they are used in the community. Often, there are differences in titration schemes and dosing options. Also, in clinical trials, drugs are rarely studied in combination, although they are often used in this manner in practice settings. Further, Phase III clinical trials (at least in psychiatry) often do not enroll a large enough sample to evaluate infrequently occurring adverse events. Rather, the predominance of information regarding rare side effects is derived from voluntary reports made after a drug comes to market—and therefore likely under-reports the phenomenon. Finally, information regarding drug safety that comes to practitioners in the form of medication warnings or advisories may reflect concerns that extend beyond the strict interpretation of clinical trials data. These and other issues represent major obstacles in attempting to fully understand issues related to safety and tolerability of medication in “real world” settings.
Future Drugs for the Treatment of Depression: The Need to Look Beyond Monoamine Systems
Authors: Rapaport Mark Hyman
Published: August 2016

Review of extant biological data would suggest that major depressive disorder (MDD) is a term used to subsume a syndrome that may involve a variety of different pathophysiological processes. Current research has implicated a myriad of different factors in the pathogenesis of depressive disorders including: genetic predisposition, “hormonal” abnormalities, disturbances in neurostransmitters, disturbances in neurocircuitry, and immune dysfunction. Our most recent consensus suggests that the depressive disorders reflect the interplay between these biological systems and psychosocial experiences, such as early-life trauma and current life stressors. Thus, MDD truly represents a complex heterogeneous syndrome. This conceptualization suggests that a variety of different types of treatment approaches will be necessary to adequately ameliorate the symptoms of patients suffering from this syndrome. Although this is a daunting task, we are beginning to develop approaches that will enable us to add to our armamentation of biological treatments.
Fibromyalgia Syndrome: Case-Based Learning
Authors: Russell I. Jon
Published: August 2016

Case-based learning is often considered a new innovation in medical teaching, but it is actually as old as clinical medicine. Physicians have always consulted with their peers on difficult cases and utilized the case-based form of discussion as an educational tool, as a means of understanding new diagnoses, and as a method of determining the best treatment for a particular patient. Fibromyalgia syndrome (FM), a common clinical disorder with a world-wide distribution, has been unrecognized and/or ignored for years. FM can be likened to a volcano, with pain at the very top and insomnia and depression as key, but less common, manifestations (Slide 1). However, many physicians are insecure about the diagnosis and treatment of patients with FM, because they simply do not know enough about the disorder.
The Diagnosis and Work-Up of Insomnia
Authors: Winkelman John W.
Published: August 2016

Most adults have difficulty sleeping at some time in their lives, with problems falling asleep, staying asleep, or having nonrestorative sleep. When these symptoms continue for ≥1 month and are associated with daytime dysfunction or distress, they reach the status of an insomnia disorder. Roughly 10% of adults in the United States have an insomnia disorder (hereafter referred to as insomnia), ie, that which is present on most nights and lasts ≥4 weeks. Insomnia can be primary, in which the sleep disturbance exists in the absence of co-existing medical or psychiatric disorders, or comorbid, when it is accompanied by one of these disorders.

Although a diagnosis of insomnia requires difficulty with sleep, insomnia is a 24-hour disorder. Individuals with insomnia describe difficulties with concentration, fatigue, and mood, which both influence, and are influenced by, the sleep disturbance. In addition, insomnia is associated with a substantially elevated risk of incident major depressive disorder (MDD), panic disorder, and substance abuse disorders. There is also emerging evidence that insomnia increases the risk for incident hypertension and diabetes.
The Treatment of Primary Insomnia
Authors: Krystal Andrew D.
Published: August 2016

There are a several therapies available for the treatment of primary insomnia, most notably cognitive-behavioral therapy (CBT) and pharmacologic treatment. The benzodiazepines are a group of chemically related compounds represented by medications such as triazolam, temazepam, and lorazepam. Non-benzodiazepines, such as zaleplon, zolpidem extended-release (ER), eszopiclone and zopiclone, act via a mechanism similar to the benzodiazepines but have a different chemical structure. Also available is the melatonin receptor agonist, ramelteon, as well as several antihistamines such as diphenhydramine, doxylamine, hydroxyzine.

Medications, such as the antidepressants trazodone, mirtazapine, doxepin, and amitriptyline as well as the antipsychotics, quetiapine, olanzapine, and risperidone, have been used off-label for the treatment of insomnia. Patients often turn to alcohol, over-the-counter agents, and melatonin for relief of their sleep problems (Slide 1).

Given these treatment options, there are several questions faced in clinical practice concerning when to treat patients for insomnia, what treatments should be used, and how long treatment should continue. CBT is typically continued for a fixed length of time. Generally, the greater the functional impairment a person experiences, the more there is to be gained from treatment. The decision about whether to treat and which treatments should be used, should consider the risks and expected benefits of all treatment options. CBT for insomnia has relatively minimal risks, with the only downsides being cost, access, and convenience. CBT should always be a therapeutic option.
Kindling and Quenching: Conceptual Links to rTMS
Authors: Weiss Susan R.B. , Li Xiu-Li , Heynen Terri , Noguera E. Christian , Li H. , Post Robert M.
Published: August 2016

Unlike the other articles in this series on rTMS, this paper will not include clinical research or magnetic stimulation experiments. Instead, we will focus on an animal model of epilepsy called kindling and a procedure that we have recently developed to inhibit kindled seizures called quenching. Both procedures involve direct intracerebral electrical stimulation of the brain. We demonstrate that low-frequency stimulation, which does not disrupt ongoing behavior, can have profound and long-lasting effects on both seizure development and fully kindled seizures.

At this point, we do not know how well these models relate, either mechanistically or phenomenologically, to the effects of repeated transcranial magnetic stimulation (rTMS); however, we believe that at the very least, some of the principles emerging from studying these phenomena may be relevant to our thinking about rTMS and its potential treatment utility. Specifically, we discuss the possible relationship between quenching and rTMS with regards to parameters of induction, possible common mechanisms, and potential treatment implications.
Repetitive TMS as a Probe in Anxiety Disorders: Theoretical Considerations and Case Reports
Authors: Greenberg Benjamin D. , McCann Una D. , Benjamin Jonathan , Murphy Dennis L.
Published: August 2016

The emergence of repetitive transcranial magnetic stimulation (rTMS) as a relatively noninvasive probe of cortical function provides an opportunity to explore the relationships between regional brain activity and symptomatology across neuropsychiatric illnesses. In this article, we briefly review evidence from functional neuroimaging studies (principally those using positron emission tomography [PET] or single-photon emission computed tomography [SPECT]) and other studies suggesting regional brain involvement in anxiety disorders, specifically obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD). We also review an initial controlled study conducted by our group using rTMS as a probe of prefrontal mechanisms in OCD. This discussion is not intended to be comprehensive, but rather to provide examples of disorders that, based on current knowledge, might be good candidates for the use of rTMS as a probe. In addition, we present case reports from pilot studies of rTMS in three patients with different primary anxiety disorder diagnoses, which illustrate some of the issues involved in such studies, as well as the effects observed. The possibility that rTMS may have therapeutic potential in anxiety disorders is also discussed.
Obsessive-Compulsive Disorder and Schizophrenia: A Phenomenological Perspective of Shared Pathology
Authors: Yaryura-Tobias Jose A. , Stevens Kevin P. , Neziroglu Fugen , Grunes Michael S.
Published: August 2016

Research evidence attests to the parallel similarities and the reciprocal nature of obsessive-compulsive disorder (OCD) and schizophrenia (SCZ) in such a manner that OCD and SCZ may progress into one another. We explore this evidence by presenting a theoretical and empirical phenomenological perspective to account for and elucidate the shared psychopathology of thought, perception, and motor impairment between these disorders. The purpose of this paper is to communicate that OCD and SCZ, while preserving their individuality, share related accounts of their phenomenology within a temporal and spatial frame of reference.
The Effects of Risperidone vs Haloperidol on Cognitive Functioning in Treatment-Resistant Schizophrenia: The Trail Making Test
Authors: Mcgurk Susan R. , Green Michael F. , Wirshing William C. , Ames Donna , Marshall B.D. , Marder Steven R. , Mintz Jim
Published: August 2016

In this article, data are presented from Parts A and B of the Trail Making Test, which examined the effects of haloperidol vs risperidone on cognitive function in treatment-resistant scxhizophrenic patients. This report focuses on findings from the Trail Making Test. Overall, risperidone had a positive effect on Trail Making Part B performance following 4 weeks of treatment. These effects were due, at least in part, to the direct effects of risperidone. The possibility that an antipsychotic agent can enhance executive functioning through direct mechanisms, perhaps mediated by frontal cortex neurochemistry, indicates that the evaluation of antipsychotic medications in the treatment of schizophrenia should be expanded to include cognition.