bluuebunny/crossref_metadata_2025 huggingface dataset:
Bone tumours
Authors: Beckingsale Thomas , Gerrand Craig
Published: February 2014

Bone tumours comprise a heterogeneous mix of post-traumatic, developmental, benign, and malignant lesions. They can be subclassified according to their histological matrix as bone-forming, cartilage-forming, or fibre-forming, although some do not produce a specific matrix. Perhaps the most important distinction is between malignant tumours, which have a predisposition to invasive and destructive local growth and distant metastasis, and benign tumours, which do not metastasize, although some can demonstrate locally aggressive behaviour. Both benign and malignant bone tumours can present with unexplained pain and swelling. Radiographic investigation is mandatory to exclude bony malignancy, avoid delay in diagnosis, and prevent incorrect treatment such as arthroscopy or steroid injection when there is an underlying tumour. The three most common malignant tumours of bone are osteosarcoma, Ewing’s sarcoma, and chondrosarcoma. If radiography indicates that bone cancer is a possibility, an urgent referral should be made to a bone cancer multidisciplinary team. Wherever possible, patients should be entered into clinical trials. Some chemosensitive tumours (e.g. osteosarcoma or Ewing’s tumours) require a combined approach to treatment, classically with adjuvant (preoperative) chemotherapy, local therapy (usually surgery), then adjuvant chemotherapy.
Renal osteodystrophy
Authors: Bardin Thomas , Drüeke Tilman
Published: February 2014

Renal osteodystrophy (ROD) is a term that encompasses the various consequences of chronic kidney disease (CKD) for the bone. It has been divided into several entities based on bone histomorphometry observations. ROD is accompanied by several abnormalities of mineral metabolism: abnormal levels of serum calcium, phosphorus, parathyroid hormone (PTH), vitamin D metabolites, alkaline phosphatases, fibroblast growth factor-23 (FGF-23) and klotho, which all have been identified as cardiovascular risk factors in patients with CKD.
ROD can presently be schematically divided into three main types by histology: (1) osteitis fibrosa as the bony expression of secondary hyperparathyroidism (sHP), which is a high bone turnover disease developing early in CKD; (2) adynamic bone disease (ABD), the most frequent type of ROD in dialysis patients, which is at present most often observed in the absence of aluminium intoxication and develops mainly as a result of excessive PTH suppression; and (3) mixed ROD, a combination of osteitis fibrosa and osteomalacia whose prevalence has decreased in the last decade.
Laboratory features include increased serum levels of PTH and bone turnover markers such as total and bone alkaline phosphatases, osteocalcin, and several products of type I collagen metabolism products. Serum phosphorus is increased only in CKD stages 4-5. Serum calcium levels are variable. They may be low initially, but hypercalcaemia develops in case of severe sHP. Serum 25-OH-vitamin D (25OHD) levels are generally below 30 ng/mL, indicating vitamin D insufficiency or deficiency.
The international KDIGO guideline recommends serum PTH levels to be maintained in the range of approximately 2-9 times the upper normal normal limit of the assay and to intervene only in case of significant changes in PTH levels. It is generally recommended that calcium intake should be up to 2 g per day including intake with food and administration of calcium supplements or calcium-containing phosphate binders. Reduction of serum phosphorus towards the normal range in patients with endstage kidney failure is a major objective. Once sHP has developed, active vitamin D derivatives such as alfacalcidol or calcitriol are indicated in order to halt its progression.
Foot and ankle
Authors: Redmond Anthony C. , Helliwell Philip S.
Published: February 2014

Foot and ankle problems have been the subject of major advances in the rheumatology in recent years. This chapter reviews the anatomy of the foot and covers the manifestations of foot pathology for the major conditions: rheumatoid arthritis, osteoarthritis, the seronegative arthritides, connective tissue disease, crystal diseases, and miscellaneous conditions including hypermobility syndrome. Relevant local conditions including plantar fasciitis, tendinopathy, and neuroma are addressed separately. The principles of assessing and treating the foot and ankle in rheumatology are covered, along with the relevant specific approaches best suited to dealing with problems associated with the major conditions.
Fibromyalgia and chronic widespread pain syndromes—adult onset
Authors: Kuttikat Anoop , Shenker Nicholas
Published: February 2014

Fibromyalgia syndrome (FMS) is characterized by chronic widespread pain, excessive fatigue, unrefreshing sleep, and other associated somatic symptoms. FMS is common in the general population with an estimated prevalence of 2-4% and is about six times more common in females than males. FMS causes significant individual and societal costs.
The precise aetiology of FMS remains unclear. Dysfunctional pain processing within the central nervous system is the primary abnormality. FMS is a clinical diagnosis based on pattern recognition and it can coexist with other conditions. A multidisciplinary approach, incorporating patient education, physical therapies, psychological therapies, and pharmacotherapy, is effective in managing these patients.
Sports and exercise injuries
Authors: Maffulli Nicola , Buono Angelo Del
Published: February 2014

Muscle, tendon, and ligament injuries are common practice in sports medicine. Muscle injuries do not require surgery but heal with traditional conservative measures, whereas surgery may be indicated in chronic high-demand patients who need to early return to preinjury activity. Ligament injuries are responsive to conservative management but, when resulting clinical instability impairs daily and sport activities, surgical repair or reconstruction are recommended. Tendinopathy is an overuse syndrome, the diagnosis of which is clinical, and confirmed by the presence of degenerative changes at histology, without any signs of inflammatory disease. The current trend is to adopt a conservative approach which also includes platelet-rich plasma and sclerosing injections, and to advocate surgery in unresponsive patients. Even though regenerative therapies are emerging, available knowledge is still scanty and literature lacks level I studies to support their use.
Amyloidosis
Authors: Hawkins Philip N.
Published: February 2014

Amyloidosis is a disorder of protein folding in which normally soluble proteins are deposited in the interstitial space as insoluble and remarkably stable fibrils that progressively disrupt tissue structure and function of organs throughout the body. Protein misfolding and aggregation have increasingly been recognized in the pathogenesis of various other diseases, but amyloidosis—the disease directly caused by extracellular amyloid deposition—is a precise term with critical implications for patients with a specific group of life-threatening disorders. Amyloidosis may be acquired or hereditary and the pattern of organ involvement varies within and between types, though clinical phenotypes overlap greatly. Virtually any tissue other than the brain may be directly involved. Although histology remains the diagnostic gold standard, developments in scintigraphy and MRI technology often produce pathognomonic findings. Systemic amyloidosis is usually fatal, but the prognosis has improved as the result of increasingly effective treatments for many of the conditions that underlie it, notably the use of biologic anti-inflammatory agents in patients with AA amyloidosis and new immunomodulatory agents in patients with AL type. Better supportive care, including dialysis and solid organ transplantation, have also influenced the prognosis favourably. A range of specific novel therapies are currently in clinical development, including RNA inhibitors that suppress production of amyloid precursor proteins, drugs that promote their normal soluble conformation in the plasma, and immunotherapy approaches that directly target the amyloid deposits.
Autoinflammatory diseases
Authors: Lachmann Helen J. , Hawkins Philip N.
Published: February 2014

The autoinflammatory diseases are disorders of innate immunity which result in chronic or recurrent multisystem inflammatory disease. This chapter concentrates on the currently known inherited periodic fever syndromes. These rare genetic diseases have resulted in major advances in the understanding of innate immunity in general and the regulation of interleukin (IL)-1 in particular. It now seems clear that autoinflammatory conditions are disorders of the regulation of IL-1 and NFκ‎‎B. The treatment and prognosis of these diseases have been radically improved by the availability of cytokine-blocking agents.
Macrophage activation syndrome
Authors: Grom Alexei A. , Ramanan Athimalaipet V.
Published: February 2014

Macrophage activation syndrome (MAS) is a life-threatening condition caused by excessive activation and proliferation of T lymphocytes and haemophagocytic macrophages. Although MAS has been reported in association with almost any rheumatic disease, it is by far most common in systemic juvenile idiopathic arthritis. Flares of the underlying disease or infection are most common triggers of MAS. The pathognomonic feature of MAS is typically found in bone marrow: numerous, well-differentiated macrophagic histiocytes phagocytosing normal haematopoietic elements. The expansion of these histiocytes leads to a massive systemic inflammatory reaction associated with three cardinal clinical features: severe cytopenias, liver dysfunction, and coagulopathy consistent with disseminated intravascular coagulation.
Clinically, MAS is strikingly similar to the autosomal recessive disorders collectively known as familial haemophagocytic lymphohistiocytosis (FHLH). FHLH has been associated with various genetic defects affecting the cytolytic pathway. Cytolytic function is profoundly depressed in MAS patients as well, and this abnormality is caused by both genetic and acquired factors.
Studies in animals suggest that uncontrolled expansion of activated CD8+ T lymphocytes secreting cytokines that activate macrophages is central to the pathophysiology of haemophagocytic syndromes. Consistent with this view, the combination of steroids and ciclosporin, an immunosuppressant that preferentially inhibits T lymphocytes, is an effective treatment for the majority of MAS patients. Patients in whom MAS remains active despite this treatment present a serious challenge and require more aggressive immunosuppression. However, in MAS triggered by infection, the optimal level of immunosuppression is difficult to determine. As a result, reported mortality rates reach 20%.
Inherited metabolic diseases
Authors: Manger Bernhard
Published: February 2014

A variety of hereditary disorders can present with structural or functional alterations of the musculoskeletal system. In particular, genetic defects within enzymatic pathways involved in the lysosomal degradation of various substrates can manifest with bone or joint symptoms. Because musculoskeletal complaints are frequently the first reason for the patient to seek medical advice, the rheumatologist may play a crucial role in the early diagnosis of these diseases. Lysosomal storage diseases are a heterogeneous group of individually very rare disorders, but taken together they have a prevalence of more than 1 in 8000 live births. Some of these lysosomal storage diseases can nowadays be treated very effectively by enzyme replacement therapies; however, a timely start of treatment is essential to avoid irreversible organ damage and deterioration of the quality of life. Therefore, the rheumatologist should be able to recognize signs and symptoms of the most frequent treatable lysosomal storage diseases.
Rheumatological manifestations of endocrine disorders
Authors: Sharma Sanjeev , Rayman Gerry
Published: February 2014

There is considerable overlap of musculoskeletal manifestations of both rheumatological and endocrine disorders. Apart for the well-described autoimmune basis governing the aetiopathogenesis of clinical states pertaining to specific conditions affecting both systems, there is more recent evidence on the overlapping biology and genetics of these organ systems. Not uncommonly, endocrine manifestations can herald the initial presentation of rheumatological illnesses and the converse holds true for endocrinopathies. Rheumatologists and physicians alike need to be astutely aware of this overlap of symptomatology and also the physiology linking both groups of clinical conditions.
This review discusses the common endocrine presentations associated with rheumatic illnesses in relation to newer information gleaned from population studies, genetic studies, and clinical presentations. A comprehensive list of rheumatological conditions found in endocrine states is also tabulated at the end.
Haemochromatosis
Authors: Carroll Graeme J. , Breidahl WIlliam H. , Olynyk John K.
Published: February 2014

The arthropathy of haemochromatosis is relatively common even in patients with hereditary haemochromatosis (HH) recruited from the community. It is a chronic, progressive arthropathy with a level of inflammatory activity that is both clinically and histopathologically intermediate between that of rheumatoid arthritis and osteoarthritis. There is a predilection for the finger metacarpophalangeal joints and it is variably, but not commonly accompanied by chondrocalcinosis. The precise mechanism responsible for tissue damage in affected joints remains unknown, however there is growing evidence that iron load is a major determinant of the arthropathy. HH arthropathy is variably responsive to phlebotomy. Whether earlier diagnosis and treatment targeted to achieve tight control of iron metabolism from an early age or as soon as possible after diagnosis could produce better outcomes remains to be determined. Novel and more effective approaches to management with a view to prevention of structural joint damage still need to be developed.
Molecular genetics and biology of dementia
Authors: Harold Denise , Williams Julie
Published: February 2014

Considerable progress has been made in our understanding of the genetics and molecular biology of dementia. In this chapter we focus predominantly on the most common form of dementia, Alzheimer’s disease (AD), but also discuss vascular dementia and frontotemporal dementia. Genetic mutations have been identified that cause Mendelian subtypes of each disorder, and in recent years genome-wide association studies have greatly aided the identification of risk genes for more common forms of disease. For example, 9 susceptibility genes have been identified in AD in the past 3 years as a result of genome-wide association studies, the first robust risk loci to be identified since APOE in 1993. This progress in genetic research is having a dramatic effect on our understanding of disease pathogenesis, by refining previous ideas and defining new primary disease mechanisms.
Physical assessment of older patients
Authors: Forsyth Duncan
Published: February 2014

Mental health problems may co-exist with or be the presenting feature of other medical illness in older age. All clinicians also need to consider the potential psychological impact of ill-health and its treatments on patients and their carers. This chapter gives a geriatrician’s guide to comprehensive geriatric assessment, identifying physiological changes that occur with ageing and the potential mental health presentations of common medical conditions. The ‘geriatric giants’ of falls, immobility, incontinence, delirium and drug toxicity are put in the context of maintaining higher-order cortical functioning to enable the individual to remain upright, mobile, continent and clear in their thinking. These are considered with admissions avoidance or safe discharge planning in mind.
Person- and relationship-centred dementia care: past, present, and future
Authors: Keady John , Nolan Mike
Published: February 2014

Dementia is a global issue but is experienced at an individual and relational level. This chapter traces the emergence of both person centred care and relationship centred care with the latter approach expressed through the Senses Framework. The theoretical development and practical application of the Senses [security, belonging, continuity, purpose, achievement, significance] are outlined highlighting the importance of staff, carer and person [with dementia in this chapter] all working together. The application of the Senses Framework to a recent practice development study set in a care home for people with dementia that used a combination of the Senses and life story work to create an 'enriched environment is then described. The chapter concludes with a discussion about how the Senses can be used to facilitate an early diagnosis of dementia and to help people with dementia and their families to engage with a life ‘outside the front door’, what we term ‘The Neighbourhood Space’.
Alzheimer’s disease
Authors: Taylor John-Paul , Thomas Alan
Published: February 2014

Alzheimer’s disease (AD) is a well recognised clinicopathological entity and the most common cause of dementia. This chapter critiques the several sets of newly proposed criteria for making the diagnosis of (AD) at different stages in the disease process, in the context of demand for earlier diagnosis and emerging biomarkers. The differential diagnosis and types of different cognitive symptoms are reviewed and the prevalence and pattern of the many non-cognitive symptoms associated with AD are considered. The management of non-cognitive symptoms is also updated, especially the circumstances in which antipsychotic drugs might be prescribed. And finally a summary of our current understanding of the aetiology (evidence for risk and protective factors for AD ) and the prognosis for AD is provided.
Frontotemporal dementia
Authors: Deramecourt Vincent , Lebert Florence , Pasquier Florence
Published: February 2014

Frontotemporal dementia (FTD) is the second most common form of dementia in persons younger than 65 years after Alzheimer’s disease. The FTD spectrum is characterized by clinical, molecular and genetic heterogeneity. Core features of FTD are behavioural and language manifestations and the clinical spectrum of FTD currently includes a behavioural variant, progressive nonfluent aphasia and semantic dementia. The most common behavioural features are disinhibition, apathy, loss of empathy, hyperorality and perseveration. Neuroimaging usually demonstrates focal atrophy and hypometabolism in the anterior part of the frontal and temporal lobes. A careful history and neuropsychological examination, and judicious use of neuroimaging, can help distinguish FTD from other common forms of dementia, especially Alzheimer’s disease, vascular dementia, and dementia with Lewy bodies. Although no specific pharmacological treatments for FTD exists, symptom management with serotonin reuptake inhibitors and non pharmacological interventions have been shown to be beneficial.
Neurological dementias
Authors: Graham Andrew
Published: February 2014

Dementia in old age is usually due to Alzheimer’s disease, cerebrovascular disease, or mixed pathology. Dementia due to other neurological disorders is uncommon, but important to recognise because management may be very different to that in primary or vascular dementia. This chapter surveys five neurological conditions that may present with dementia in later life: idiopathic normal pressure hydrocephalus (INPH); Huntington’s disease (HD); multiple sclerosis (MS); autoimmune limbic encephalitis (LE); and prion disease. For each disorder the epidemiology, clinical features, investigations & treatment are reviewed, with examples of the characteristic brain imaging changes. Accurate diagnosis of these conditions can be challenging even for physicians with a special interest in dementia, and often requires a neurological referral.
Management of dementia
Authors: Cullum Sarah
Published: February 2014

The management of dementia discusses the needs of people in both the early and later stages of dementia, focusing on social and environmental aspects as well as physical and psychological. The main management tasks in early dementia are helping the person with dementia and their family come to terms with the diagnosis, optimising quality of life in the present, and planning for the future. In later dementia we deal with maintaining person-hood, the emergence of behavioural and psychological symptoms of dementia, making decisions for a person who no longer has capacity to do so for themselves, and end of life care in people who are increasingly frail and have limited ability to communicate their needs. Underpinning all of these is the need for respect and communication, and to provide person-centred and relationship-centred care for people with dementia and their carers.
Delirium
Authors: Hogg Jenny
Published: February 2014

Delirium (acute confusional state) is a common condition affecting between ten and thirty percent of a general hospital inpatient population. The diagnosis is suspected when there is an acute onset of confusion in the presence of a physical precipitant. Pre-existing dementia, advancing age, previous delirium and increasing illness severity favour the development of delirium. The diagnosis of delirium is solely clinical and can be quickly arrived at using assessment tools such as the cognitive Assessment Method (CAM). Historical perspectives, diagnosis, the use of assessment tools, differential diagnosis, communication with patients and relatives, prevention, prognosis, and treatment are discussed in this chapter, along with the pathophysiology of this common condition
Anxiety disorders in older people
Authors: Byrne Gerard
Published: February 2014

Anxiety symptoms and anxiety disorders are highly prevalent among older people, including among those with physical frailty and cognitive impairment. Clinicians are advised to consider the effects of prescribed medication and other substances, and the influence of general medical conditions, in the older person presenting with anxiety. Psychological treatments are recommended for older people with anxiety disorders of mild to moderate severity. These include relaxation training, exposure-based interventions, and cognitive behaviour therapy. Pharmacological interventions are in widespread use, although there is little evidence in support of the long-term use of either benzodiazepines or antipsychotics in older people with anxiety disorders. Instead, treatment with antidepressant medication is recommended.
Late-onset schizophrenia
Authors: Brunelle Sarah , Vahia Ipsit V. , Jeste Dilip V.
Published: February 2014

Although schizophrenia with onset in middle or late-life is a relatively uncommon, a considerable proportion of patients do experience the first manifestations of the disease after the age of forty. The current nomenclature utilizes terminology based on age at onset: late-onset schizophrenia (LOS) for illness with onset between ages 40 and 60, and very-late-onset schizophrenia-like psychosis (VLOSLP) for onset after age 60. Recent evidence suggests more similarities than differences in epidemiology, etiology or risk factors and clinical presentation between these clinical entities, although a later onset seems to be associated with better premorbid functioning and female gender. Relatively stable cognitive deficits are observed in patients regardless of age at onset and LOS is generally not associated with a dementia, although VLOSLP are more likely to be associated with neurodegenerative processes. Antipsychotic medication is the mainstay of treatment and some psychosocial interventions may prove beneficial, but there is a lack of clinical trials focused on patients with onset in late-life. Response to treatment and outcomes tend to be better than among those with earlier onset, but special consideration should be given to biological and psychosocial factors related to the older age of patients
The ethics of caring
Authors: Baldwin Clive , Estey-Burtt Brandi
Published: February 2014

This chapter outlines an ethics of caring by examining the philosophical basis of caring as well as components of the caring relationship in a psychiatric setting. It draws on the philosophy of Emmanuel Levinas, particularly his idea of the Self’s responsibility toward a vulnerable and radically different Other. It also argues that Deleuze and Guattari’s notion of ‘lines of flight’ challenges modern conceptualizations of personhood by positing a personhood based on sociality, fluidity, and multiplicity. Narrative presents a link between responsibility to the Other and respect for the Other’s personal process of becoming and thus may be used as a caring approach in psychiatry. An ethics of caring thus promotes the wellbeing of the patient by means of responsible, dynamic relationality for which narrative offers one promising expression.
Elder abuse
Authors: Manthorpe Jill
Published: February 2014

Old age psychiatrists will encounter situations of elder abuse in their practice. Whatever their work and professional policies they will need to think the unthinkable and to provide leadership to teams and across services. Asking and observing what is happening are key elements of their role. There is further need to work collaboratively to support older people at risk and to empower then by fostering or sustaining resilience. Old age psychiatrists can assist in prevention and in the building of supportive communities. They have a key role to play in furthering research and the creation of effective interventions for perpetrators. Their engagement with staff and residents in care homes may prevent poor practice and diminish opportunities for abuse and neglect.
A Companion to the Classification of Mental Disorders
Authors: Cooper John E. , Sartorius Norman
Published: February 2014

A Companion to the Classification of Mental Disorders provides essential reading as a background and supplement to both the recently produced DSM-5 and the forthcoming ICD-11. It focuses on the processes of classification and diagnosis, and the uses for these classifications. This resource emphasises the dangers of regarding any current psychiatric classification as true or complete, in view of the present partial state of knowledge about the causes and mechanisms of most mental and behavioural disorders. It is unique in containing a number of chapters that give a brief history of the cooperative efforts and projects necessary for the production of internationally agreed psychiatric classifications. The discussion begins in 1965 with the US/UK Diagnostic study, the preparations for ICD-8 with its first international glossary, and the International Pilot Study of Schizophrenia, designed and coordinated by the World Health Organization. While recognizing the importance of the innovations of the DSM series of classifications of the American Psychiatric Association, the resource also takes a truly international perspective. The expert authors are well placed to do this, having been personally involved in many of the collaborative studies and developments discussed.
First steps towards international agreement on diagnosis and classification
Authors: Cooper John E. , Sartorius Norman
Published: February 2014

By the time Stengel’s report (noted in the last chapter) was published in 1960, psychiatrists on both sides of the Atlantic had already reacted to the increasing difficulty of communication. They did this by developing glossaries that were systematic descriptions of symptoms that did not rely upon theoretical assumptions or interpretations. The first of these to be published was the UK Glossary of Mental Disorders for ICD-8 (1967), and this led the WHO to produce, after a further period of wide international consultation, the first glossary to chapter V of ICD-8 (1974). During this period, there was a parallel development of standardized and structured interviewing and rating schedules aimed at increasing the inter-rater reliability of the descriptions of symptoms upon which descriptive diagnoses could be based. This happened independently, in the USA (Biometrics Department of Columbia University, New York) in the form of the Mental Status Schedule (MSS), and in London (Institute of Psychiatry, University of London) where the Present State Examination(PSE) was produced.
Developments in the USA
Authors: Cooper John E. , Sartorius Norman
Published: February 2014

DSM-I and DSM-II were not widely used, even in the USA, although DSM-II followed the main headings of chapter V of ICD-7. In the post-WWII war expansion of psychiatry the 1950s and 1960s most psychiatrists USA were oriented towards various types of psycho-dynamic psychotherapy, but academic centres in Washington University, St. Louis and the Biometrics Department of Columbia University in New York retained an strong interest in descriptive psychiatry. When the time came for preparation of DSM-III, R.L .Spitzer of the Biometrics Department was appointed chairman, and he enrolled many psychiatrists in the USA in a variety of working groups and task-forces for the consultations required. The publication of DSM-III in 1980 was a major event for American psychiatry in that it provided a list of symptoms in descriptive terms, by which each disorder could be identified, together with instructions as to how many of the list were required to qualify for the diagnosis. This radical innovation met with some resistance from those members of the American Psychiatric Association who were still predominantly oriented towards psycho-dynamic varieties of psychotherapy, but was finally approved. DSM-III was such a success that it set the basic pattern for a revision (DSM-III-R) in 1987, DSM-IV in 1994. and DSM-IV-TM in 2000.
Large Community-Based Diagnostic Studies in the USA
Authors: Cooper John E. , Sartorius Norman
Published: February 2014

After the publication of DSM-III in 1980, the next major diagnostic event in the USA was the NIMH Epidemiological Catchment Area (ECA) study. This aimed to estimate the distribution of DSM-III disorders in the general population .For this, an interviewing procedure, the Diagnostic Interview Schedule (DIS) was developed, which could be administered to selected subjects by specially trained lay interviewers. Five catchment areas were chosen; these were St Louis, (Kansas), Baltimore, Durham (North Carolina), New Haven (Connecticut) , and Los Angeles, each of which contained an already established research centre. The findings of the ECA study, particularly the high rate of co-occurrence of disorders, stimulated the National Co-morbidity Survey ten years later (1990-1992). This used a national probability sample, rather than being restricted to specified catchment areas. The National Co-morbidity Replication Survey ten years after that (2001-2003) confirmed the findings of the previous surveys, although generally reporting somewhat higher rates of occurrence for most of the disorders.
Other large community-based diagnostic surveys
Authors: Cooper John E. , Sartorius Norman
Published: February 2014

Several large community-based diagnostic surveys have been carried out in different countries in recent decades, following the ECA studies of the USA. In China, the Chinese National Epidemiological Survey of Mental Disorders was carried out in 1982, using 51,982 subjects in 12 Centres. In the UK in 1995, the Office of Population and Census Surveys conducted a study of Psychiatric Morbidity in four selected groups totalling some 14,000 persons. A collaborative European Study of the Epidemiology of Mental Disorders was completed in 2005, using 21,425 subjects in 6 countries, and the World Mental Health Survey of the WHO using 85, 052 subjects in 17 countries was done in 2005. Most of these surveys used the CIDI interview. The results of these surveys were broadly similar, but detailed comparisons cannot be made because different types of mental health statistics were reported from the different surveys. A striking common finding was that large proportions of persons with mental disorders have never sought care from mental health services. These surveys do not have a direct or immediate effect upon the provision of mental health services. In any community, the need for mental health services, the demands made for such services,the availability of services and the governmental and local policies to provide services have a complicated and not direct relationship.
Towards international agreement on classification
Authors: Cooper John E. , Sartorius Norman
Published: February 2014

The changes that could be introduced into Chapter V of ICD-9, published in 1978, were comparatively limited because of the conservative policy that applied to all the Chapters of the ICD at that time. Nevertheless, some badly needed improvements were included, such as a better treatment of disorders of childhood and adolescence, and reactions to stress. The Joint Project between the NIMH of the USA and the Division of Mental Health of the WHO was the next major development, with the aim of keeping differences between the forthcoming DSM-IV and Chapter V of ICD-10 to a minimum. This started with literature reviews, leading to a major conference in Copenhagen in 1982, followed by a varied programme of the development of interviewing and rating instruments suitable for use in international cooperative projects. The DIS was expanded into the Composite International Diagnostic Interview (CIDI), the PSE into the Schedules for Clinical Assessment in Neuropsychiatry (SCAN), and the International Personality Disorder Examination (IPDE) schedule was also produced. When a draft of the chapter V of ICD-10 became available, the Joint Project also funded the attendance of several WHO advisors at some meetings of the Task Forces that were preparing DSM-IV. The WHO also produced four mutually compatible versions of Chapter V of the ICD-10; these are i) a very short version for the main ICD-10 volume to go with the other 20 chapters of the whole ICD, ii) the Clinical Descriptions and Diagnostic Guidelines (CDDG), the full clinical version for use by psychiatrists in clinical work, iii) the Diagnostic Criteria for Research (DCR-10), and iv) the Diagnostic and Management Guidelines for Mental Disorders in Primary Care (ICD-10-PHC).
Diagnosis in psychiatry
Authors: Cooper John E. , Sartorius Norman
Published: February 2014

A diagnosis is best defined as the underlying cause of the presenting symptoms; it is expressed in the terms and concepts of the healer or contemporary doctor. Modern medical knowledge allows physicians and surgeons to make many diagnoses based upon aetiology that lead immediately to specific treatment, but limited knowledge of brain and psychological functions does not allow psychiatrists to do this for many psychiatric patients. The diagnostic process in contemporary psychiatry depends upon interviewing, followed by summarizing the symptoms identified in terms of a chosen diagnostic system. The diagnostician’s perception of the symptoms is rapid, and subject to interpretation; standardised interview and rating schedules, such as the PSE, SCAN, DIS and CIDI have been developed for research purposes that minimise the variation between interviewers. There is still debate about whether to identify diagnostic categories by means of narrative descriptions or lists of criteria or both. In clinical practice there are drawbacks to relying only upon lists of criteria. A dimensional approach to diagnosis is often debated, but the lack of dimensions which can be measured reliably remains a major problem.
How to use a psychiatric classification
Authors: Cooper John E. , Sartorius Norman
Published: February 2014

One of the main uses for case-notes is to help in the diagnosis and treatment of any future episodes of illness. It is therefore worth taking some trouble to include as accurate a diagnosis as possible in the records of a current episode. This chapter contrasts what is probably a very common way of recording a diagnosis with what should be done to give maximum benefit to all concerned.
Clinical Cardiology
Authors: Katritsis Demosthenes G. , Gersh Bernard J. , Camm A. John
Published: February 2014

The purpose of this book is to provide a useful, easily accessible, and user-friendly clinical tool that can be used in the every day clinical practice. Definition, epidemiology, aetiology, and pathophysiology and genetics of cardiac diseases are summarized according to recent evidence. Presentation of diseases, physical findings and investigations for a contemporary, evidence- based approach are organized in a clear and instructive manner. The management of the patient is presented according to most recent randomized control trials and recommendations of guidelines by the ACC/AHA and the ESC. Most recent guidelines and updates have been collected for each topic, and current recommendations have been extracted and presented in abbreviated tables. The reference list is aimed at presenting seminal studies that support statements in the book, randomized control trials that are dictating modern management, and scholarly, instructive reviews that have appeared in the major cardiology journals. Recent only articles are presented in order to guide potential further reading. The on-line editions of the book are updated on a regular basis.
Injury severity scoring systems
Authors: Rosengart Matthew
Published: February 2014

Discerning who the most critically injuredpatients are from among the overall population ofinjured necessitates a method by which to estimate the risk of an outcome, suchas death, and thus identify who would benefit from this higher level of care.Injury severity scoring is simply a means by which to do this, to characterize andquantify an injury. It has been extended to estimating the risk of an outcome(e.g., mortality, morbidity, length of stay). The scores themselvesdraw upon characteristics of the patient (anatomic, physiologic, comorbidity)to construct a summary measure quantifying a patient–s condition after injury.These have been incorporated into a fourth type of score that combines theseelements to enhance the predictive capacity.
Monitors and drains in trauma patients
Authors: Piper Greta L. , Kaplan Lewis J.
Published: February 2014

Monitors are essential for assessment of the critically ill patient. It is necessaryto understand the basics, as well as the intricacies, of when and why touse certain monitors, as well as how to interpret the results within the contextof other clinical signs and symptoms. Intensive-care patient monitors areconstantly evolving to better, faster, and more automated technology, but thehuman physiology behind the newer tools remains the same.
Resuscitation from hemorrhagic shock
Authors: Reynolds Benjamin R. , Watson Gregory A.
Published: February 2014

Shock from massive hemorrhage can be one of the most difficultproblems to manage in the intensive care unit. Severe hemorrhagic shock and the resulting “lethal triad” of coagulopathy, hypothermia, and acidosis are associated with a very high morbidity and mortality. Achieving a good outcomerequires prompt recognition of hemorrhage and institution of measuresto stop bleeding, as well as timely resuscitation and reversal of coagulopathy, hypothermia, and acidosis. In this chapter, we will differentiate hemorrhagic from other types of shockand describe its pathophysiology. Treatment will be emphasized, utilizing theextreme example of “damage control” to guide the discussion.
Orthopedic trauma
Authors: Zelle Boris A. , Siska Peter A. , Tarkin Ivan S.
Published: February 2014

A significant number of trauma patients sustain musculoskeletal injuries. As comparedto major head, thoracic, abdominal, and vascular injuries, most musculoskeletal injuries are not immediately life threatening. However, the long-termfunctional outcomes of polytrauma patients are often predicated on their orthopedicinjuries. Thus, thoughtful and timely treatment of fractures and dislocationsplays a major role in the management protocol of the severely injuredpatient.
Traumatic brain injury: assessment, pathophysiology, and management
Authors: Grandhi Ramesh , Okonkwo David O.
Published: February 2014

Traumatic brain injury (TBI) is the most common cause of death among individuals under 45 years of age in the Western World. Each year, roughly 1.7 millionpeople in the United States sustain head injuries, most of which are concussionsor mild TBI. However, brain trauma has a significant impact in the United States, as underscored by the approximately 52,000 deaths and 275,000 hospitalizationsper year, as well as the considerable financial burden placed on the healthcare systemin terms of direct medical expenditures, including long-term care to patientswith disabilities from TBI, and indirect costs related to loss of productivity.
Pediatric trauma
Authors: Rutigliano Daniel , Gaines Barbara A.
Published: February 2014

Management of pediatric trauma and the care of critically ill children are complexand evolving fields. Practitionerscaring for these children should take note of the differences in injury patternsas well as the response to injury and critical illness of children in comparison toadults; children should not be managed as “little adults.” Whenever possibleexposure to radiation should be kept to a minimum, non-operative management of solid organ injuries is standard-of-care, and early nutritional support is paramountto recovery. Children with severe traumatic brain injury and/or complexchest and abdominal injuries would best be served by transfer to the nearesthigh-level pediatric facility.
Critical care and trauma in pregnancy
Authors: Brown Joshua , Marshall Gary T.
Published: February 2014

Intensive care unit (ICU) admission is required in < 1% of pregnant women;however, maternal and fetal mortality can increase several-fold in critically-illpregnant patients. Trauma is one of the frequent causes of maternal/fetal mortality, along with venous thromboembolism, hemorrhage, and hypertensive disorders.Diligent management of maternal conditions and risk factors carries thegreatest benefit to the fetus. Early involvement of obstetric expertise is stronglyadvised in all cases.
Rehabilitation considerations of trauma patients
Authors: Deluca Kerry , Wagner Amy
Published: February 2014

Assessment of the rehabilitation needs of the trauma patient begins in the Trauma Intensive Care Unit (ICU). Physiatrists, specialists in the field of PhysicalMedicine and Rehabilitation (PM&R), focus on a patient–s current and potentialfunctional impairment(s) with the goal of maximizing functional ability despitephysical and cognitive limitations.To best determine the appropriate level of postacute therapies, the physiatristconsiders prior level of function, living situation, and level of social support aswell as the patient–s current medical needs, functional level, and therapy needs.In some populations, early rehabilitation involvement inpatient care leads to better acute outcomes and decreased length of stay inacute care.
General Organization
Authors: Fisch Adam
Published: February 2014

Chapter 1 gives an overview of neuroanatomy, including orientational terminology for the dorsal, ventral, rostral, caudal, medial, lateral, sagittal, coronal, and axial areas of the cerebral hemisphere and brain stem, as well as divisions and signs, including Babinski's sign.
Peripheral Nervous SystemUpper Extremity
Authors: Fisch Adam
Published: February 2014

Chapter 3 discusses how to draw the peripheral nervous system (upper extremities), including the brachial plexus, median nerve, ulnar nerve, radial nerve, and the cervical plexus.
Peripheral Nervous SystemLower Extremity
Authors: Fisch Adam
Published: February 2014

Chapter 4 discusses how to draw the peripheral nervous system (lower extremities), including the lumbosacral plexus, the leg and foot, and the thigh.
Peripheral Nervous SystemSensory Maps
Authors: Fisch Adam
Published: February 2014

Chapter 5 discusses how to draw sensory maps of the peripheral nervous system, including the hand, foot, dermatomes, cutaneous nerves of the upper limb, lower limb, and trunk, as well as discussing referred pain.
Cranial Nerves 3, 4, 6, 12
Authors: Fisch Adam
Published: February 2014

Chapter 12 discusses cranial nerves 3, 4, 6, 12 and their anatomy, as well as extraocular movements, extraocular muscles (recti muscles and oblique muscles) and oculomotor nuclei.
Eye Movements
Authors: Fisch Adam
Published: February 2014

Chapter 23 discusses eye movements, including the final common pathway, horizontal saccade circuitry and details, vertical saccades, smooth pursuit, and the pupillary light reflex.
Coma with Fever
Authors: Levin Morris
Published: February 2014

Chapter 1 presents a case regarding coma with fever, and discusses bacterial meningitis, bacterial cultures with regard to antibiotic therapy, CSF gram stains, and corticosteroids.
Post Carotid Endarterectomy Neurological Deficit
Authors: Levin Morris
Published: February 2014

Chapter 3 presents a case regarding post carotid endarterectomy neurological deficit, and discusses that carotid endarterectomy is generally safe, but postoperative complications include stroke and hyperperfusion syndrome, that in endarterectomy patients who develop focal deficits in the perioperative period, immediate CT of the head is recommended to exclude hemorrhage, that vascular imaging is essential to determine the presence of thrombosis or dissection of the carotid artery, that anticoagulation is the standard treatment for postendarterectomy thrombosis or dissection, but intra-arterial thrombolysis and stenting are alternatives that are being studied, how assessment of cranial arterial blood flow is important in determining the presence of the hyperperfusion syndrome, and that nanagement of arterial blood pressure is crucial if hyperperfusion syndrome is suspected.
Persistent Migraine Aura
Authors: Levin Morris
Published: February 2014

Chapter 4 presents a case regarding persistant migraine with aura, and discusses development and resolution times, other causes of possible focal deficits, abnormal MRI with DWI, and MR or CT imaging along with EEG to rule out other pathological causes, and treatments to halt prolonged auras, including magnesium sulfate, divalproex, oxygen, and verapimil.
Contraindication to Lumbar Puncture
Authors: Levin Morris
Published: February 2014

Chapter 5 presents a case regarding contraindication to lumbar puncture, and discusses coagulation dysfunction, thrombocytopenia with platelet count above 40,000, and transfusion immediately before LP, as well as pharmacological anticoagulation needing to be corrected prior to LP.
Diffuse Weakness
Authors: Levin Morris
Published: February 2014

Chapter 6 presents a case regarding diffuse weakness, and discusses acute Guillain-Barré syndrome without a clear history of antecedent infection, differential diagnoses with similar symptomology, the need to include a thorough metabolic screening as well as LP, and the need for early spinal imaging if there is any suspicion of myelopathy.
Subacute Paraparesis in an Elderly Patient
Authors: Levin Morris
Published: February 2014

Chapter 7 presents a case regarding subacute paraparesis in an elderly patient, and discusses multifactorial gait dysfunction in the elderly, the need to identify and distinguish acute spinal lesions from chronic spondylitic and other conditions, normal pressure hydrocephalus vs out-of-proportion hydrocephalus to any expected 'ex vacuo' ventriculomegaly due to brain atrophy, quality of life issues, and collaborative approaches with family, patient, caregivers, and social workers.
Syncope
Authors: Levin Morris
Published: February 2014

Chapter 9 presents a case regarding syncope, and discusses how it can results from many causes including cardiovascular, pulmonary, metabolic, neurological, and psychogenic, how careful general, cardiac, pulmonary, and neurological history and exams are essential, including careful assessment of pulse and blood pressure bilaterally and in different positions, how laboratory investigation of syncope should include metabolic and hematological panels, cardiac enzymes, ECG, chest x-ray, EEG, echocardiography, and cardiac monitoring, and that cerebrovascular imaging should likewise be considered in cases of syncope accompanied by any focal neurological defi cits or when there is a suspicion of seizure.