bluuebunny/crossref_metadata_2025 huggingface dataset:
Phenotypic and transcriptional response to selection for alcohol sensitivity in Drosophila melanogaster
Authors: Morozova Tatiana V , Anholt Robert RH , Mackay Trudy FC
Published: October 2007

Background

Alcoholism is a complex disorder determined by interactions between genetic and environmental risk factors. Drosophila represents a powerful model system to dissect the genetic architecture of alcohol sensitivity, as large numbers of flies can readily be reared in defined genetic backgrounds and under controlled environmental conditions. Furthermore, flies exposed to ethanol undergo physiological and behavioral changes that resemble human alcohol intoxication, including loss of postural control, sedation, and development of tolerance.

Results

We performed artificial selection for alcohol sensitivity for 35 generations and created duplicate selection lines that are either highly sensitive or resistant to ethanol exposure along with unselected control lines. We used whole genome expression analysis to identify 1,678 probe sets with different expression levels between the divergent lines, pooled across replicates, at a false discovery rate of q < 0.001. We assessed to what extent genes with altered transcriptional regulation might be causally associated with ethanol sensitivity by measuring alcohol sensitivity of 37 co-isogenic P-element insertional mutations in 35 candidate genes, and found that 32 of these mutants differed in sensitivity to ethanol exposure from their co-isogenic controls. Furthermore, 23 of these novel genes have human orthologues.

Conclusion

Combining whole genome expression profiling with selection for genetically divergent lines is an effective approach for identifying candidate genes that affect complex traits, such as alcohol sensitivity. Because of evolutionary conservation of function, it is likely that human orthologues of genes affecting alcohol sensitivity in Drosophila may contribute to alcohol-associated phenotypes in humans.
Intracellular zinc homeostasis in leukocyte subsets is regulated by different expression of zinc exporters ZnT-1 to ZnT-9
Authors: Overbeck Silke , Uciechowski Peter , Ackland M Leigh , Ford Dianne , Rink Lothar
Published: October 2007

Intracellular zinc homeostasis is strictly regulated by zinc binding proteins and zinc transporters. In the present study, we quantified in a first global view the expression of all characterized human zinc exporters (hZnT-1-9) in different leukocyte subsets in response to zinc supplementation and depletion and analyzed their influence on alterations in the intracellular zinc concentration. We found that hZnT-1 is the most regulated zinc exporter. Furthermore, we discovered that hZnT-4 is localized in the plasma membrane similar to hZnT-1. hZnT-4 is most highly expressed in Molt-4, up-regulated after treatment with PHA and is responsible for the measured decrease of intracellular zinc content after high zinc exposure. In addition, we found that hZnT-5, hZnT-6, and hZnT-7 in Raji as well as hZnT-6 and hZnT-7 in THP-1 are up-regulated in response to cellular zinc depletion. Those zinc exporters are all localized in the Golgi network, and this type of regulation explains the observed zinc increase in both cell types after up-regulation of their expression during zinc deficiency and, subsequently, high zinc exposure. Furthermore, we detected, for the first time, the expression of hZnT-8 in peripheral blood lymphocytes, which varied strongly between individuals. While hZnT-2 was not detectable, hZnT-3 and hZnT-9 were expressed at low levels. Further on, the amount of expression was higher in primary cells than in cell lines. These data provide insight into the regulation of intracellular zinc homeostasis in cells of the immune system and may explain the variable effects of zinc deficiency on different leukocyte subsets.
Attenuated translocation of group IVa phospholipase A2 and up-regulated annexin-1 synthesis by glucocorticoid blocks β2-integrin adhesion in neutrophils
Authors: Meliton Angelo Y , Munoz Nilda M , Zhu Xiangdong , Leff Alan R
Published: October 2007

We examined the effect of glucocorticoid stimulation in blocking β2-integrin adhesion of polymorphonuclear leukocytes (PMNs) isolated from human subjects. Surface expression of CD11b and ERK-1/2-mediated gIVaPLA2 phosphorylation, which are required for β2-integrin adhesion, were not affected by treatment with ≤10−6 M fluticasone propionate (FP) for PMNs activated by either 10−7 M LTB4 or 30 ng/ml TNF-α and caused no significant blockade of β2-integrin adhesion in vitro. Baseline expression of annexin-1 (ANXA1) synthesis was increased only after 10−6 M FP for PMNs; by contrast, comparable increase in ANXA1 expression was demonstrated in human eosinophils from the same subjects with 10−8 M FP. Viability of PMNs was verified by propidium iodide and by the persistence of β2-integrin adhesion in treated groups. Exogenous administration of ANXA1 mimetic peptide fragment blocked significantly and comparably the β2-integrin adhesion in PMNs activated by LTB4 and TNF-α and in eosinophils activated by IL-5. Translocation of gIVaPLA2 from the cytosol to the nucleus also was refractory for activated PMNs treated with ≥10−7 M FP; by contrast, complete blockade of nuclear translocation of cytosolic gIVaPLA2 was effected by 10−9 M FP in eosinophils. Our data indicate that the cell surface ANXA1 synthesis is capable of blocking β2-integrin adhesion in both PMNs and eosinophils. However, in contrast to eosinophils, FP does not cause either substantial ANXA1 synthesis or nuclear transport of cytosolic gIVaPLA2 in PMNs and thus does not block β2-integrin adhesion, a necessary step for granulocyte cell migration in vivo.
Expression of Gal4-dependent transgenes in cells of the mononuclear phagocyte system labeled with enhanced cyan fluorescent protein usingCsf1r-Gal4VP16/UAS-ECFP double-transgenic mice
Authors: Ovchinnikov Dmitry A , van Zuylen Wendy J M , DeBats Claire E E , Alexander Kylie A , Kellie Stuart , Hume David A
Published: October 2007

We generated double-transgenic mice carrying cointegrated tissue-specific Gal4 and Gal4 reporter transgenes to direct transgene overexpression in the mononuclear phagocyte system (MPS). A modified promoter of the Csf1r (c-fms) gene, containing a deletion of the trophoblast-specific promoter, was used to drive the expression of Gal4VP16 transcriptional activator specifically in macrophages. This module was cointegrated with a fluorescent reporter, enhanced cyan fluorescent protein (ECFP), driven by a Gal4-dependent promoter. ECFP fluorescence was first detected in forming blood islands of the yolk sac at 8 dpc, then in macrophages in the yolk sac and the embryo proper. In adult mice ECFP was detected primarily in monocytes, tissue macrophages, microglia, and dendritic cells, including Langerhans cells of the skin. Crossing of these mice to transgenics containing tagged protein under control of a Gal4-dependent promoter directed expression of that protein in mononuclear phagocytes of double-transgenic animals. The new mouse line provides a useful tool for overexpression of transgenes in cells of the myeloid lineage, while simultaneously labeling them by ECFP expression.
Recognising and managing antidepressant discontinuation symptoms
Authors: Haddad Peter M. , Anderson Ian M.
Published: October 2007

Antidepressant discontinuation symptoms occur with all classes of antidepressant. A well-described discontinuation syndrome occurs with the selective serotonin reuptake inhibitors, common symptoms including dizziness, headache, nausea and lethargy. Rare antidepressant discontinuation syndromes include extrapyramidal syndromes and mania/hypomania. All these syndromes, even isolated discontinuation symptoms, share three common features that facilitate diagnosis; abrupt onset within days of stopping the antidepressant, a short duration when untreated and rapid resolution when the antidepressant is reinstated. Clinicians need to be familiar with strategies for the prevention and management of such symptoms. Preventive strategies include warning patients about the possibility of discontinuation symptoms, encouraging good antidepressant adherence and tapering antidepressants at the end of treatment. Most symptoms are mild and short-lived. Consequently symptoms that follow planned termination of an antidepressant can often be managed by providing an explanation and reassurance. More severe symptoms should be treated symptomatically or the antidepressant restarted, in which case symptoms usually resolve within 24 h. More cautious tapering can then follow.
The work patterns of consultant psychiatrists
Authors: Harrison Judith
Published: October 2007

Much has changed in the National Health Service in the UK in the past 10 years and consultant roles need to adapt accordingly. This article describes the drivers for change in consultant roles, including enhanced roles for other mental health professionals, increased expectations of users and carers, changes in junior doctors' work patterns and the new consultant contract. The recommendations of the report on New Ways of Working for Psychiatrists are reviewed, with suggestions for changes in the consultant role in out-patient clinics, community teams and acute care. Enhanced roles for other mental health professionals and the increasing trend to specialisation are also discussed.
Why don't patients attend their appointments? Maintaining engagement with psychiatric services
Authors: Mitchell Alex J. , Selmes Thomas
Published: October 2007

Patients miss about 20% of scheduled appointments for mental health treatment, almost twice the rate in other medical specialties. Up to 50% of patients who miss appointments drop out of scheduled care. Many who miss appointments because of slips and lapses later rearrange their appointments without adverse consequences. Those that do not are at risk of further deterioration, relapse and hospital readmission. Predictors of non-attendance are complex and linked with the predictors of missed medication. Service barriers and administrative errors are common but are often overlooked in the absence of feedback from patients. Of prime importance are the therapeutic alliance and degree of ‘helpfulness’ of the clinician but again these are rarely measured routinely. Useful markers of engagement include patient-rated trust, satisfaction and degree of perceived participation in treatment decisions. Much can be done to improve attendance in most services. Simple measures such as offering prompt, convenient appointments, offering reminders and augmenting with telephone contact have a reasonable evidence base. Scales to assess therapeutic alliance are now available. Complex interventions need to be evaluated carefully in order that the overall benefits outweigh costs. We suggest that clinicians consider accessibility, discharge policies and patient feedback when examining local rates of non-attendance.
The cognitive behavioural analysis system of psychotherapy: a new psychotherapy for chronic depression
Authors: Swan John S. , Hull Alastair M.
Published: October 2007

The cognitive behavioural analysis system of psychotherapy (CBASP) is a new therapy specifically designed to treat chronic depression. Conceptually the bio-psychosocial signs and symptoms of chronic depression are viewed as the result of either arrested maturational development at a Piagetian preoperational stage (in early-onset patients) or heightened emotionality and general functional regression (in late-onset patients). In this therapy, patients learn how their cognitive and behavioural patterns produce and perpetuate interpersonal problems and how to alter maladaptive patterns of interpersonal behaviour. The focus is primarily on interpersonal interactions, including with the therapist, through the latter's disciplined personal involvement. In this article we outline the therapy process and key mechanisms of change using examples to illustrate specific techniques. We also outline the theoretical model underpinning CBASP and summarise the evidence from a large clinical trial.
Cannabis use and psychosis: the origins and implications of an association
Authors: Macleod John
Published: October 2007

Evidence for the effectiveness of treatment or secondary prevention of psychotic illness such as schizophrenia is often disappointing. This situation reflects our limited understanding of the aetiology of psychosis. There is good evidence that both genetic and environmental factors are implicated but the precise identity of these is unclear. Cannabis use is one candidate as a possible, modifiable environmental influence on both incidence and prognosis of psychosis. Evidence supporting this candidature is exclusively observational, and its strength has perhaps been overestimated and problems related to its interpretation underestimated by some. Nevertheless the possibility that cannabis does cause psychosis remains. Because of this, and because there are other good public health reasons to prevent cannabis use, interventions targeting use need to be evaluated. This evaluation, along with other imaginative approaches to future research, is needed to further our understanding of the determinants of mental illness and how we can most effectively improve the population's mental health.
Why do psychiatrists have difficulty disengaging with the out-patient clinic?
Authors: Killaspy Helen
Published: October 2007

In this issue ofAPTMitchell & Selmes present an article detailing why patients miss appointments and how clinicians should respond. Many of the papers quoted relate to the psychiatric out-patient clinic. In this commentary as well as picking up on some of the themes that emerge from their article, I explore the attachment that psychiatrists seem to have to this particular model of patient contact.
Recovery: our common purpose?
Authors: Roberts Glenn , Hollins Sheila
Published: October 2007

The Royal College of Psychiatrists' Annual General Meeting in Edinburgh in June 2007 witnessed the launch of the joint position statement from the College, the Care Services Improvement Partnership and the Social Care Institute for Excellence ‘A Common Purpose: Recovery in Future Mental Health Services’ as part of its opening session. This is now available as a stimulus and a guide for clinicians and teams to consider how to engage in the recovery agenda and whether to make it their common purpose also.
Off-label prescribing in psychiatric practice
Authors: Baldwin David S. , Kosky Nick
Published: October 2007

Drug treatment is an essential part of much of psychiatric practice, in patients from a wide age range, across many diagnostic groups and in a variety of settings. Despite the availability of many classes of psychotropic drug, significant numbers of patients remain troubled by distressing and disabling symptoms even after a succession of licensed pharmacological treatments. Psychiatrists may then consider the prescription of a psychotropic outside the narrow terms of its licence, as part of an overall management plan. This article reviews the nature and extent of this aspect of prescribing, outlines when it may be appropriate and makes recommendations for a suggested procedure when prescribing medication ‘off-label’.
Epidemiology: what it is and why it matters
Authors: Kelly Brendan D.
Published: October 2007

Epidemiology is the study of why, how and how often diseases occur in given populations. There is now a sufficiency of epidemiological evidence for psychiatrists to warn that cannabis use could increase risk of psychosis in later life. The policy impact of this accumulated epidemiological evidence is difficult to predict. There is a strong need to develop models of mental health policy-making that incorporate careful interpretation of epidemiological evidence.
Impact and clinical significance of a preventive intervention for disruptive boys
Authors: Boisjoli Rachel , Vitaro Frank , Lacourse Éric , Barker Edward D. , Tremblay Richard E.
Published: October 2007

Background

Many intervention programmes have attempted to reduce disruptive behaviour problems during early childhood to prevent maladjustment during adolescence and adulthood.

Aims

To assess the long-term impact and clinical significance of a 2-year multicomponent preventive intervention on criminal behaviour and academic achievement, using intention-to-treat analyses.

Method

Targeted disruptive–aggressive boys considered to be at risk of later criminality and low school achievement (n=250), identified from a community sample (n=895), were randomly allocated to an intervention or a control group. The rest of the sample (n=645) served as the low-risk group. The intervention was multimodal and aimed at boys, parents and teachers. Official data measured both outcomes.

Results

Significantly more boys in the intervention group (13%; P<0.05) completed high-school graduation and generally fewer (11%; P=0.06) had a criminal record compared with those allocated to the control group.

Conclusions

The results suggest that early preventive intervention for those at high risk of antisocial behaviour is likely to benefit both the individuals concerned and society.
Effects of training community staff in interventions for substance misuse in dual diagnosis patients with psychosis (COMO study)
Authors: Johnson Sonia , Thornicroft Graham , Afuwape Sarah , Leese Morven , White Ian R. , Hughes Elizabeth , Wanigaratne Shamil , Miles Helen , Craig Tom
Published: October 2007

A cluster randomised controlled trial was used to investigate the effectiveness of training staff in 13 London community mental health teams (CMHTs) to deliver substance misuse interventions to patients with psychosis and comorbid substance misuse (‘dual diagnosis’). The primary hypotheses, which were that experimental group patients would spend fewer days in hospital over 18 months of follow-up and show reduced alcohol and drug consumption, were not confirmed, although confidence intervals were wide for some outcomes. Current UK policy guidance advocates training CMHT professionals to deliver dual diagnosis interventions, but the effectiveness of this strategy has not so far been demonstrated.
Antidepressant effects of augmentative transcranial magnetic stimulation
Authors: Herwig Uwe , Fallgatter Andreas J. , Höppner Jacqueline , Eschweiler Gerhard W. , Kron Martina , Hajak Göran , Padberg Frank , Naderi-Heiden Angela , Abler Birgit , Eichhammer Peter , Grossheinrich Nicola , Haya Birgit , Kammer Thomas , Langguth Berthold , Laske Christoph , Plewnia Christian , Richter Melany M. , Schulz Merten , Unterecker Stefan , Zinke Antonia , Spitzer Manfred , Schönfeldt-Lecuona Carlos
Published: October 2007

Background

Repetitive transcranial magnetic stimulation (rTMS) has been proposed as a new treatment option for depression. Previous studies were performed with low sample sizes in single centres and reported heterogeneous results.

Aims

To investigate the efficacy of rTMS as augmentative treatment in depression.

Method

In a randomised, double-blind, sham-controlled multicentre trial 127 patients with moderate to severe depressive episodes were randomly assigned to real or sham stimulation for 3 weeks in addition to simultaneously initiated antidepressant medication.

Results

We found no difference in the responder rates of the real and the sham treatment groups (31% in each) or in the decrease of the scores on the depression rating scales.

Conclusions

The data do not support previous reports from smaller samples indicating an augmenting or accelerating antidepressant effect of rTMS. Further exploration of the possible efficacy of other stimulation protocols or within selected sub-populations of patients is necessary.
Psychophysiological and behavioural characteristics of individuals comorbid for antisocial personality disorder and schizophrenia-spectrum personality disorder
Authors: Schug Robert A. , Raine Adrian , Wilcox Rand R.
Published: October 2007

Background

Few studies have examined people with comorbid schizophrenia-spectrum personality disorder and antisocial personality disorder, a subgroup who may differ psychophysiologically and behaviourally from those with either condition alone.

Aims

To test whether individuals with both types of personality disorder are particularly characterised by reduced orienting and arousal and by increased criminal offending.

Method

In a community adult sample, self-reported crime and skin conductance orienting were collected on four diagnostic groups: schizophrenia-spectrum personality disorder only; antisocial personality disorder only; comorbidity of the two disorders; and a control group.

Results

The comorbid group showed significantly higher levels of criminal behaviour than the other three groups. They also showed reduced skin conductance orienting to neutral tones compared with the other groups, and significantly reduced arousal and orienting to significant stimuli compared with the control group.

Conclusions

Reduced orienting may reflect a neurocognitive attentional risk factor for both antisocial and schizotypal personality disorders that indirectly reflects a common neural substrate to these disorders.
Intergenerational transmission of health beliefs in somatoform disorders
Authors: Marshall Tamsin , Jones David P. H. , Ramchandani Paul G. , Stein Alan , Bass Christopher
Published: October 2007

Children of parents with a range of psychiatric disorders are at increased risk of developing psychological disturbance themselves. There is growing evidence that this includes children who have parents with a chronic somatoform disorder. The health beliefs of children with a parent with a somatoform disorder were compared with those of children with a parent with an organic physical disorder. Children of parents with somatoform disorder scored higher on bodily preoccupation and disease phobia scales and their health beliefs showed similarities to the beliefs of their parents.
Does compulsory or supervised community treatment reduce ‘revolving door’ care?
Authors: Kisely Stephen , Campbell Leslie Anne
Published: October 2007

Supervised community treatment to address ‘revolving door’ care is part of the new Mental Health Act in England and Wales. Two recent epidemiological studies in Australia (n> 118 000), as well as a systematic review of all previous literature using appropriately matched or randomised controls (n= 1108), suggest that it is unlikely to help.
Genotype effects of CHRNA7, CNR1 and COMT in schizophrenia: interactions with tobacco and cannabis use
Authors: Zammit Stanley , Spurlock Gillian , Williams Hywel , Norton Nadine , Williams Nigel , O'Donovan Michael C. , Owen Michael J.
Published: October 2007

Background

Genetic variations might modify associations between schizophrenia and cannabis or tobacco use.

Aims

To examine whether variants within the cannabinoid receptor (CNR1) and α7 nicotinic receptor (CHRNA7) genes are associated with schizophrenia, and whether these effects vary according to cannabis or tobacco use. We also examined a putative interaction between cannabis and Val158Met within the catechol-O-methyltransferase gene (COMT).

Method

Genotype effects of CHRNA7 and CNR1 were studied in a case–control sample of 750 individuals with schizophrenia and 688 controls, with interactions for these genes studied in small subsamples. A case-only design of 493 of the schizophrenia group was used to examine interactions between cannabis use and COMT.

Results

There was no evidence of association between schizophrenia and CNR1 (OR=0.97, 95% CI 0.82–1.13) or CHRNA7 (OR=1.07, 95% CI 0.77–1.49) genotypes, or of interactions between tobacco use and CHRNA7, or cannabis use and CNR1 or COMT genotypes.

Conclusions

Neither CNR1 nor CHRNA7 variation appears to alter the risk of schizophrenia. Furthermore, our results do not support the presence of different effects of cannabis use on schizophrenia according to variation within COMT.
Prevalence of depressive symptoms and syndromes in later life in ten European countries
Authors: Castro-Costa Erico , Dewey Michael , Stewart Robert , Banerjee Sube , Huppert Felicia , Mendonca-Lima Carlos , Bula Christophe , Reisches Friedel , Wancata Johannes , Ritchie Karen , Tsolaki Magda , Mateos Raimundo , Prince Martin
Published: October 2007

Background

The EURO–D, a 12-item self-report questionnaire for depression, was developed with the aim of facilitating cross-cultural research into late-life depression in Europe.

Aims

To describe the national variation in depression symptoms and syndrome prevalence across ten European countries.

Method

The EURO–D was administered to cross-sectional nationally representative samples of non-institutionalised persons aged ≥50 years (n = 22 777). The effects of age, gender, education and cognitive functioning on individual symptoms and EURO–D factor scores were estimated. Country-specific depression prevalence rates and mean factor scores were re-estimated, adjusted for these compositional effects.

Results

The prevalence of all symptoms was higher in the Latin ethno-lingual group of countries, especially symptoms related to motivation. Women scored higher on affective suffering; older people and those with impaired verbal fluency scored higher on motivation.

Conclusions

The prevalence of individual EURO–D symptoms and of probable depression (cut-off score ≥4) varied consistently between countries. Standardising for effects of age, gender, education and cognitive function suggested that these compositional factors did not account for the observed variation.
Economic evaluation of a randomised controlled trial for anorexia nervosa in adolescents
Authors: Byford Sarah , Barrett Barbara , Roberts Chris , Clark Andrew , Edwards Vanessa , Smethurst Nicola , Gowers Simon G.
Published: October 2007

Background

Young people with anorexia nervosa are often admitted to hospital for treatment. As well as being disruptive to school, family and social life, in-patient treatment is expensive, yet cost-effectiveness evidence is lacking.

Aims

Cost-effectiveness analysis of three treatment strategies for adolescents with anorexia nervosa.

Method

UK multicentre randomised, controlled trial comparing in-patient psychiatric treatment, specialist out-patient treatment and general out-patient treatment. Outcomes and costs assessed at baseline, 1 and 2 years.

Results

There were 167 young people in the trial. There were no statistically significant differences in clinical outcome between the three groups at 2 years. The specialist out-patient group was less costly over the 2-year follow-up (mean total cost £26 738) than the in-patient (£34 531) and general out-patient treatment (£40 794) groups, but this result was not statistically significant. Exploration of the uncertainty associated with the costs and effects of the three treatments suggests that specialist out-patient treatment has the highest probability of being cost-effective.

Conclusions

On the basis of cost-effectiveness, these results support the provision of specialist out-patient services for adolescents with anorexia nervosa.
The medical model is dead – long live the medical model
Authors: Shah Premal , Mountain Deborah
Published: October 2007

Many people criticise, and psychiatrists apologise, for the use of the ‘medical model’. We examine what is currently meant by this term and suggest a refinement of definition to reflect the ideals and contemporary practice of medicine. We propose that psychiatrists should use the medical model to improve and validate bio-psychosocial psychiatric medicine.
Are people with schizophrenia more logical than healthy volunteers?
Authors: Owen Gareth S. , Cutting John , David Anthony S.
Published: October 2007

We tested a phenomenological hypothesis about theoretical and practical rationality in people with schizophrenia. This hypothesis states that in schizophrenia there is an enhancement of theoretical rationality Our case–control experiment supported this hypothesis. Philosophical models of rationality that prioritise theoretical over practical rationality may thereby apply more in schizophrenic than in healthy states. The study is an example of how experimental psychopathology can illuminate areas of philosophical dispute that are difficult to settle by thought alone.
Feasibility of a structured risk assessment tool in general adult psychiatry admissions
Authors: Smith Helen , White Tom
Published: October 2007

AIMS AND METHOD

To assess the feasibility of using a structured risk assessment tool (Historical Clinical Risk 20-Item (HCR–20) Scale) in general adult psychiatry admissions and the characteristics of ‘high-risk’ patients. A notes review and interviews were used to conduct an HCR–20 assessment of 135 patients admitted to Murray Royal Hospital, Scotland.

RESULTS

Patients scoring higher on the HCR–20 were discharged earlier and more likely to have a diagnosis of personality disorder and a comorbid diagnosis.

CLINICAL IMPLICATIONS

It was possible to complete an HCR–20 assessment of over 80% of patients within 48 h of admission.
The College and the independent sector
Authors: Sugarman Philip , Nimmagadda Seshagiri Rao
Published: October 2007

Independent psychiatry beyond the National Health Service (NHS) is growing in the UK. However the history of the College can lead it to be NHS-centred in its outlook. Psychiatrists engaged in ‘private practice’ have at times been excluded from their collegiate peer group. We explore here the underlying and challenging issues of professional values, stigma, and occupational motivation. In the spirit of its commitment to raising standards, it is pleasing that the College is beginning to look beyond the NHS, supporting the professional development of non-NHS members, and including them in quality initiatives. We must all discover the value for patients in an open and independent perspective on what drives psychiatry in the UK.
Recruitment into psychiatry: views of consultants in Scotland
Authors: Brown Tom M. , Addie Karen , Eagles John M.
Published: October 2007

AIMS AND METHOD

By use of a postal survey we sought to determine attitudes and beliefs about recruitment to psychiatry. Members of the Scottish Division of the Royal College of Psychiatrists were asked to complete a questionnaire asking their views on the importance of various factors in relation to recruitment (n=387).

RESULTS

Response rates were low from non-consultants and we focused on the views of the 212 consultants (55%) who responded. The perceived low status of psychiatry among other doctors and the belief that individuals with psychiatric disorders are difficult to deal with emerged as the two most important factors seen to affect recruitment. Improving undergraduate teaching in psychiatry was deemed important in enhancing recruitment.

CLINICAL IMPLICATIONS

Dealing with stigma, within and out with the profession, and improving undergraduate exposure to psychiatry may be important in recruiting doctors to psychiatry.
Setting up and evaluating a cognitive–behavioural therapy training programme for psychiatric trainees
Authors: Martinez Rebeca , Horne Rebecca
Published: October 2007

Psychotherapy training provision within psychiatry training schemes differs across the UK. In the light of the current changes in training structures, adjustments may be required in the way that psychotherapy training is delivered and assessed. This paper reports on the development, delivery and evaluation of a cognitive–behavioural therapy (CBT) training programme for psychiatric trainees within a training scheme with limited psychotherapy resources.
Forensic psychiatry in Europe
Authors: Gordon Harvey , Lindqvist Per
Published: October 2007

The European Union now includes 27 member states. The Council of Europe stretches even further with 45 member states. A comprehensive definition of Europe geographically embraces all of Eastern Europe, including the western part of Russia and the western part of Turkey. Increasing mobility and national cooperation within Europe requires enhancing mutual knowledge and understanding of the context of evaluation and treatment of mentally disordered offenders and similar individuals who manifest antisocial behaviour and violence. A recent study confined to the previous 15 member states of the European Union provides a useful baseline for subsequent European comparisons (Salize & Dressing, 2005).
Patients' views on the quality of care when receiving electroconvulsive therapy
Authors: Kershaw Kerry , Rayner Lauren , Chaplin Robert
Published: October 2007

AIMS AND METHOD

To examine patients' views on the quality of care they received before, during and after electroconvulsive therapy (ECT), a questionnaire was completed by 389 patients who had received ECT at ECT Accreditation Service (ECTAS) member clinics.

RESULTS

The nine key standards set by ECTAS relating to quality of patient care were rated as having been met by 65% or more respondents. Most patients found staff friendly and reassuring and often commented on how this had helped reduce their anxiety prior to ECT. Patients were less positive about standards relating to being introduced to staff prior to ECT, and the quality of the waiting and post-recovery areas.

CLINICAL IMPLICATIONS

Patient views are important indicators of quality of care and should be used to improve ECT practice. Anxiety about ECT is helped by supportive and caring staff. Improvements could be made to practices related to waiting for and recovering from ECT.
MTAS fiasco: lessons for psychiatry
Authors: Whelan Paul , Jarrett Peter , Meerten Maja , Forster Kate , Bhugra Dinesh
Published: October 2007

AIMS AND METHODS

The recent Medical Training Application System (MTAS) has been fraught with problems. A survey of MTAS applicants from two London training schemes and a request for emails from trainees and trainers documenting problems with the system were undertaken with the aim of canvassing the views of candidates and shortlisters/interviewers about MTAS, and providing evidence of the system's failings.

RESULTS

A total of 101 candidates responded to the survey, and the first 92 emails sent to the Royal College of Psychiatrists were analysed. The majority of respondents (73%) were dissatisfied with MTAS and 63% thought the system unfair. UK and European Economic Area (EEA) applicants (71%) were more successful in being shortlisted than non-EEA candidates (48%). The majority of applicants (70%) planned to reapply in subsequent rounds if they failed to secure a training post.

CLINICAL IMPLICATIONS

Both surveys showed clearly that the system was not working well. The trainees and trainers both felt that the system was flawed and that the reasons for the failure included a centralised system without any piloting, and the question design. In addition a lack of resources added to the stress and burden on both trainees and trainers.
Attitude toward Death: Does It Influence Dental Fear?
Authors: FÁBIÁN GÁBOR , MÜLLER ORSOLYA , KOVÁCS SZILVIA , NGUYEN MINH TÚ , FÁBIÁN TIBOR KÁROLY , CSERMELY PÉTER , FEJÉRDY PÁL
Published: October 2007

Abstract:  The possible influence of fear of death and attitude toward death were studied related to dental anxiety in Hungarian elementary and secondary school subjects (n= 277; 114 males, 163 females; age between 8 and 18 years). Dental fear and anxiety scores were DAS: 10.8 ± 3.6; DFS: 40.6 ± 15.6; STAI‐S: 38.0 ± 11.0; STAI‐T: 40.3 ± 10.0. Lester's Attitude Toward Death Scale scores were 6.3 ± 1.3. Girls scored higher on DAS, STAI‐S, and STAI‐T scales (P≤ 0.05). Age influenced STAI‐S, STAI‐T, and Lester's Scale scores (P≤ 0.05). Lester's Scale scores influenced the expectations of the subjects about the dental fear of their surrounding people (parents, brother, sister, friends) (P≤ 0.05). A percentage of 7.22 of the subjects indicated a rather strong connection between dental fear and fear of death. These subjects had significantly higher dental fear and anxiety scores as compared to others (P≤ 0.01). Death‐related content was found in 4.3% of drawings and in 10.5% of free associations (couplings) related to teeth (in 12.6% either in drawings or in couplings). The appearance of death‐related content was higher with higher age, and higher expected dental fear of surrounding people (P≤ 0.01). Our data indicate a detectable influence of fear of death on dental fear, especially in subjects with higher dental fear scores.
Variation in Stress Responses within a Bacterial Species and the Indirect Costs of Stress Resistance
Authors: FERENCI THOMAS , SPIRA BENY
Published: October 2007

Abstract:  Bacteria can exhibit high levels of resistance to one or more environmental stresses such as temperature, osmolarity, radiation, pH, starvation, as well as resistance to noxious chemicals and antibiotics. Yet evolution has not optimized stress resistance in all bacteria to all stresses. Even within a species like Escherichia coli, stress resistance is not constant between strains, suggesting that selection for stress resistance is under counterselection in some environments. The tradeoffs associated with stress resistance in E. coli are due to more than the direct cost of resistance mechanisms. A significant indirect cost is that high stress resistance is associated with a reduced ability to compete for poor growth substrates like acetate or even good substrates like glucose at suboptimal concentrations. High stress resistance also decreases the ability to use inorganic nutrients like phosphate. This tradeoff between self‐preservation and nutritional competence, called the SPANC balance, is likely to be the major selective influence in natural populations. Another cost of high stress resistance in E. coli is an elevated mutation rate and the increased generation of deleterious mutations. Directional adaptations in SPANC balance and mutation rate are environment‐dependent. The most common variations in SPANC are due to polymorphisms in the levels of global regulators RpoS and ppGpp between different strains. High levels favor stress resistance, and low levels allow better nutrition. The intimate association of RpoS/ppGpp with stress resistance and SPANC balancing influences numerous cellular processes and bacterial properties, including virulence.
Review on Bacterial Stress Topics
Authors: GIULIODORI ANNA MARIA , GUALERZI CLAUDIO O. , SOTO SARA , VILA JORDI , TAVÍO MARÍA M.
Published: October 2007

Abstract:  A complex network of regulatory systems ensures a coordinated and effective response to different types of stress that can act on a bacterium. Bacterial stress response generates changes that influence efflux system and virulence factor expression. Thus, partial or total loss of pathogenicity islands in uropathogenic Escherichia coli can be induced by SOS‐dependent or SOS‐independent pathways related to selection of quinolone‐resistant mutants. Likewise, hyperosmolarity and some chemicals, including fluoroquinolones, salicylate, nonantimicrobial medicaments like diazepam and anti‐inflammatory drugs are all able to induce an increased active efflux, cyclohexane tolerance, loss of porins, and decreased susceptibility to multiple antimicrobials in enterobacterial strains, suggesting that bacterial response to the stress caused by an increase in osmolarity might be linked to the development of the multidrug‐resistant phenotypes. Finally, a sudden downshift of the growth temperature (cold‐shock) triggers a drastic reprogramming of bacterial gene expression to allow cell survival under the new unfavorable conditions. The strategy developed by E. coli to reach this goal consists in the induction of a set of (cold‐shock) genes whose expression is regulated at both transcriptional and posttranscriptional levels.
Chaperonopathies by Defect, Excess, or Mistake
Authors: MACARIO ALBERTO J. L. , DE MACARIO EVERLY CONWAY
Published: October 2007

Abstract:  The stress response, stress proteins, heat‐shock genes and proteins, molecular chaperone genes and proteins, and a number of closely related molecules and cellular processes have been studied over the last few decades. A huge amount of information has accumulated that is scattered in printed and electronic literature and databases. Most of this information constitutes the subject matter of the science of chaperonology. More recently, the concept of chaperone pathology, sick chaperones, has evolved since various pathological conditions have been identified in which defective chaperones play an etiologic role. These conditions are the chaperonopathies. Recent findings on chaperonopathies are briefly discussed in this article. Chaperonopathies occur at all ages; as a rule the genetic cases have an early clinical onset while the acquired chaperonopathies become manifest in the elderly and/or in association with other diseases. Other fields of chaperonology, which will most likely be expanded in the near future, are the study of extracellular chaperones, chaperone networks, the therapeutic use of chaperones (i.e., chaperonotherapy) to manage chaperonopathies and to improve cell performance in the face of stress, the evaluation of chaperones as diagnostic markers and as prognostic indicators, and the development of antichaperone agents to suppress chaperone‐gene expression or inhibit chaperone function when chaperones contribute to disease rather than the opposite.
Chaperones and Proteases—Guardians of Protein Integrity in Eukaryotic Organelles
Authors: LEIDHOLD CLAUDIA , VOOS WOLFGANG
Published: October 2007

Abstract:  Organelles like mitochondria, chloroplasts, or the endoplasmic reticulum are essential subcompartments of eukaryotic cells that fulfill important metabolic tasks. Organellar protein homeostasis is maintained by a combination of specific protein biogenesis processes and protein quality control (PQC) mechanisms that together guarantee the functional state of the organelle. According to their endosymbiontic origin, mitochondria and chloroplasts contain internal PQC systems that consist of a cooperative network of molecular chaperones and proteases. In contrast, the endoplasmic reticulum employs the main cytosolic degradation machinery, the proteasome, for the removal of damaged or misfolded proteins. Here we present and discuss recent experimental insights into the molecular mechanisms underlying organellar PQC processes.
Stress Sensitization in Schizophrenia
Authors: YUII KUNIO , SUZUKI MICHIO , KURACHI MASAYOSHI
Published: October 2007

Abstract:  It is well known that environmental factors, such as early life events, perinatal damage, and urbanicity, which interact with multiple genes, induces persistent sensitization to stress possibly through an imbalance in interactions between dopaminergic and glutamatergic systems. This stress sensitization may be critical in the development or relapse of schizophrenia. The neural correlates of a negative mood might be impaired, resulting in stress sensitization and difficulties in social adjustment (Dr. Habel). Urbanicity is associated with later schizophrenia. Metabolic stress induces stress sensitization via dysregulation of dopaminergic and/or noradrenergic systems in activated HVA and cortical response (Dr. Marcelis). The glutamatergic regulation activates HPA axis in stress response (Dr. Zelena). Ameloblast activity in human molar's enamel slowed by exposure to stress, and the segment of enamel rods is smaller, making a particular dark line. Stress sensitization may be induced at the age of 10.5 to 11.5 years resulting from severe emotional stress at the age of 10.5 to 11.5 years (Dr. Yui). It has been reported that volume reductions in the amygdala, hippocampus, superior temporal gyrus, and anterior parietal cortex common to both patient groups may represent the vulnerability to schizophrenia, while volume loss of the prefrontal cortex, posterior parietal cortex, cingulate, insula, and fusiform cortex preferentially observed in schizophrenia may be critical for overt manifestation of psychosis (Dr. Suzuki).
Molecular Mechanisms of Light Stress of Photosynthesis
Authors: VASS IMRE , CSER KRISZTIÁN , CHEREGI OTILIA
Published: October 2007

Abstract:  Photosynthesis is the basic energy conversion process on Earth, which makes possible the utilization of the energy of sunlight for living organisms. However, light is not only the basic driving force of photosynthesis, but also an important stress factor at the same time. Light‐induced decline of photosynthetic activity, generally denoted as photoinhibition, is a general phenomenon in all oxygenic photosynthetic organism under conditions when the metabolic processes cannot keep up with the electron flow produced by the primary photoreactions. Although light‐induced damage occurs in all pigmented photosynthetic complexes the primary site of photoinhibition is the photosystem II (PSII) complex, which performs light‐driven oxidation of water to protons and oxygen. The main factors, which are responsible for the light sensitivity of photosystem II, are excited pigment molecules, oxygen, manganese, as well as electron donors with high‐oxidizing potential. Photosystem II can be efficiently protected from photodamage by the combination of harmless dissipation of absorbed light energy, nonradiative charge recombination, and repair of damaged reaction center complexes, making possible the safe utilization of light, the highly energetic substrate of photosynthesis.
New Tricks for an Old Dog
Authors: MORANO KEVIN A.
Published: October 2007

Abstract:  The Hsp70 chaperone is arguably the most studied member of the heat shock protein family, a legacy traced back to the early days of phage genetics. However, much still remains to be learned about this essential protein‐folding machine. Its involvement in a number of human pathologies, ranging from cancer to protein aggregation diseases, underscores the need for a comprehensive understanding of the myriad cellular roles Hsp70 plays and the outstanding open questions. This article will explore several exciting avenues of research into the function and biology of the chaperone. Analysis of the many eukaryotic Hsp70 isoforms has demonstrated distinct functional roles for some Hsp70 members, to the point of transition from a protein “foldase” to a chaperone cofactor. New insights gained from structural studies have unveiled a likely model for interdomain communication and thus regulation of substrate binding and processing. Advances in small molecule modulation of Hsp70 activity are likely to have significant clinical impact. There is also a growing realization that Hsp70 participates in distinct functional networks in partnership with other protein chaperones. The field is thus at an exciting time when the substantial successes of the past have provided a solid framework that will be used to fuel both discovery and application—Hsp70, from molecule to man.
Stress, Heat Shock Proteins, and Autoimmunity
Authors: VAN EDEN WILLEM , WICK GEORGE , ALBANI SALVATORE , COHEN IRUN
Published: October 2007

Abstract:  Especially since the (re‐)discovery of T cell subpopulations with specialized regulatory activities, mechanisms of anti‐inflammatory T cell regulation are studied very actively and are expected to lead to the development of novel immunotherapeutic approaches, especially in chronic inflammatory diseases. Heat shock proteins (Hsp) are possible targets for regulatory T cells due to their enhanced expression in inflamed (stressed) tissues and the evidence that Hsp induce anti‐inflammatory immunoregulatory T cell responses. Initial evidence for an immunoregulatory role of Hsp in chronic inflammation was obtained through analysis of T cell responses in the rat model of adjuvant arthritis and the findings that Hsp immunizations protected against the induction of various forms of autoimmune arthritis in rat and mouse models. Since then, immune reactivity to Hsp was found to result from inflammation in various disease models and human inflammatory conditions, such as rheumatoid arthritis (RA), type 1 diabetes, and atherosclerosis. Now, also in the light of a growing interest in T cell regulation, it is of interest to further explore the mechanisms through which Hsp can be utilized to trigger immunoregulatory pathways, capable of suppressing such a wide and diversified spectrum of inflammatory diseases.