bluuebunny/crossref_metadata_2025 huggingface dataset:
Introduction
Authors: Klein Donald , O'Brien Charles P.
Published: August 2016

Pharmacoepidemiology, the study of the effects of drugs in large numbers of people, is a relatively new discipline that applies the methods of epidemiology to clinical pharmacology. Premarketing clinical trials remain the only way to scientifically determine whether a drug is causally effective, yet these trials do not provide information that allows for estimates about rare, late, or off-label toxicities associated with the drug in question. Increasing concern about common and debilitating adverse effects of medications has highlighted the need for enhanced postmarketing surveillance to follow up on clinical trials. There is a further concern regarding the broader issue of the risk-benefit ratio of certain medications. Computerized databases are a good source of information on which to lay the foundations of postmarketing research. A system of cross-linked computerized medical records may better enable researchers and physicians to realistically monitor postmarketing safety and incorporate monitoring benefits. The same research could also elucidate the net public health effect of regulatory decisions. The Veterans Affairs database in the United States and PHARMO in the Netherlands may represent good models on which to base future postmarketing surveillance studies.

In this expert roundtable supplement, Brian L. Strom, MD, provides an overview of the appropriate use of large computer databases in pharmacoepidemiology studies. Philip Wang, MD, DrPH, discusses the advantages of pharmacoepidemiologic studies over clinical trials in correctly detecting drug safety issues. Francesca Cunningham, PharmD, reviews a large computer database that is currently in use within the VA healthcare system, and Ron M.C. Herings, PharmD, PhD, discusses the development of the PHARMO system in the Netherlands.
Neuroprotection: A New Strategy in the Treatment of Schizophrenia
Authors: Lieberman Jeffrey A. , Buckley Peter F. , Perkins Diana O.
Published: August 2016

Intervention in the progression of schizophrenia is an effort not just to deter psychosis but also to protect the brain from physiologic deterioration. Neurodegeneration is believed to result from neurochemical dysregulation during the onset of schizophrenia. Deterioration accrued over recurring psychotic episodes causes cumulative loss of cell processes, loss of gray matter volume, and apoptosis. Neurodegeneration ultimately results in persistent symptomology and functional impairment. Functional decline occurs early in the course of schizophrenia, and the symptoms that emerge during the prodromal stage may derail the normal adolescent neurodevelopment. Both first-episode psychosis and the prodrome may be opportunities to forestall neurodegeneration. Unfortunately, people with schizophrenia often experience a long duration of untreated psychosis. Treatment of first-episode psychosis with antipsychotic agents shows robust response. However, early-stage patients have very high rates of medication noncompliance. Treatment in the prodrome may offer the best chance to delay the onset of illness, mitigate its severity after onset, or even prevent onset of symptoms entirely. Nonpharmacologic treatments during the prodrome, such as education, treatment for substance use, and cognitive-behavioral therapy, are low-risk interventions that are potentially beneficial. Pharmacologic interventions during the prodrome are also effective in delaying onset of illness, but carry the risk of adversely affecting patients who are false positives for prodromal schizophrenia.

In this Expert Roundtable Supplement, Jeffrey A. Lieberman, MD, provides an overview of the neurobiological basis of neurodegeneration and the concept of neuroprotection. Next, Peter F. Buckley, MD, reviews the importance of first-episode psychosis, including duration of untreated illness and medication adherence. Finally, Diana O. Perkins, MD, MPH, reviews treatment strategies for prodromal schizophrenia.
Somatic Symptoms of Depression and Anxiety in the Western Pacific Region: Questions and Answers
Authors: Clarke David M. , Hatim Ahmad , Ho Brian , Pan Jiyang , Ng Chee , Oh Kang-Seob , Wenyuan Wu , Ki-Yan Mak
Published: August 2016

It is a commonly held belief among mental health care providers that patients from the Western Pacific region with major depressive disorder (MDD) and anxiety disorders disproportionately present with somatic symptoms as opposed to emotional symptoms. Cultural norms, such as the stigma associated with psychiatric disorders, may lead members of this population to ignore the emotional aspects of these disorders or deny the presence of psychological symptoms. Empirical support is provided by the lower prevalence of these disorders in some Western Pacific nations in relation to the rest of the world. For example, MDD rates in India (9%), Japan (2%), China (2% to 4%), Malaysia (8%) and Australia (3%) are generally lower than rates in the United States (16%) and worldwide (10%). These discrepancies may be the result of missed diagnoses. Misdiagnosis is related to the increased somatization of MDD symptoms in these populations. As defined by the WHO, the Western Pacific region consists of 37 countries with a total population of 1.8 billion people (1.3 billion in China alone) with diverse cultural backgrounds and demographic profiles, which makes the issue of cultural effects on MDD diagnosis more complex.

Patients with MDD or anxiety disorders worldwide often present with somatic symptoms, which frequently accompany psychological symptoms. For example, in a recent report of pooled data from Canada, scores on the Somatic Symptoms Inventory, the 17-item Hamilton Rating Scale for Depression (HAM-D17), and the Hamilton Rating Scale for Anxiety (HAM-A) were used to evaluate the association between somatic symptoms and MDD. Of the 2,191 patients randomly enrolled in the study, 78% reported moderate-to-severe fatigue and weakness. Painful physical symptoms commonly occur in patients with anxiety disorders as well. In a European study, painful physical symptoms were reported by 28% of those without anxiety disorders and 45% of those with anxiety disorders.
Pharmacologic Treatment of Panic Disorder
Authors: Stevens Julie C. , Pollack Mark H.
Published: August 2016

Panic disorder, frequently complicated by agoraphobia in the clinical setting, is a relatively common disorder that is associated with significant morbid burden and dysfunction in affected individuals. PD treatment is focused on the reduction of panic attacks, avoidance behavior, and anticipatory anxiety, as well as the resolution of comorbid conditions, with the goal of normalizing function and improving overall quality of life. Antidepressants, including the selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors, as well as benzodiazepines, are commonly used as primary pharmacotherapies for the treatment of PD, with a variety of other novel interventions potentially useful as well, to optimize treatment outcome.
Adding Cognitive-Behavioral Therapy to Pharmacotherapy for Panic Disorder: Issues and Strategies
Authors: Otto Michael W. , Powers Mark , Smits Jasper A. J.
Published: August 2016

Despite ample evidence of the efficacy of cognitive-behavioral therapy (CBT) for the treatment of patients with panic disorder (PD), dissemination of this evidence is proceeding slowly. This article highlights some of the issues surrounding the dissemination of CBT for PD and suggests strategies for integrating CBT with pharmacotherapy. Treatment principles, with attention to the modification of CBT protocols for use in a brief-contact format, are reviewed. The principles and application of exposure interventions are discussed for both in vivo (situational) and interoceptive (feared anxiety sensations) exposure, with emphasis on the learning of safety in the context of feared sensations of anxiety. Contextual factors that may affect the success of exposure interventions and cognitive and informational interventions are also discussed.
New Approaches in Managing Chronic Insomnia
Authors: Neubauer David N.
Published: August 2016

Despite a high prevalence in the United States, insomnia remains underdiagnosed and undertreated. Extensive research has identified several factors that contribute to the inadequate treatment of insomnia, including the failure of patients to report insomnia to physicians, limited physician training, and physician misconceptions about the risks associated with hypnotic medications. To achieve optimal patient outcomes, physicians differentiate acute from chronic insomnia and distinguish primary insomnia from sleep disorders that occur with comorbid conditions, most notably psychiatric illnesses such as circadian rhythm disturbances. In addition, they utilize sleep hygiene measures, behavioral therapy, and/or pharmacologic medications to improve sleep problems in patients with insomnia. Newer nonbenzodiazepine receptor agonists are effective with fewer side effects than older benzodiazepine agonists; however, in 2005 a National Institutes of Health panel on chronic insomnia management indicated that clinical trials are needed to establish the long-term benefits of the newer drugs. Since 2005, data from clinical trials lasting 6 months to 1 year have been published for hypnotics including eszopiclone, zaleplon, and zolpidem extended-release. As the result of potentially altered dosing and monitoring, elderly patients require special consideration.
Nonstimulants and Emerging Treatments in Adults with ADHD
Authors: Newcorn Jeffrey H.
Published: August 2016

Treatment of attention-deficit/hyperactivity disorder (ADHD) may positively impact the neurobiology of adult patients with ADHD. Treatment may also minimize impairment from core symptoms and may alter the course of co-morbid disorders such as depression and substance use disorder. However, much of the information on stimulant use in adult ADHD comes from studies conducted in children, and it remains unclear whether there is a difference between children and adults when it comes to the side effects and tolerability of ADHD treatments. It is known that clinical presentation differs between adults and children, with adults demonstrating a higher percentage of mood disorders. Current treatments for adult ADHD include psychosocial therapies and pharmacologic therapies, the latter of which include the stimulants d-methylphenidate extended release (XR), OROS methylphenidate, lisdexamfetamine, and mixed amphetamine salts XR; and the nonstimulant atomoxetine, a selective norepinephrine reuptake inhibitor. There is need for additional study of treatment strategies for adult ADHD. Although all classes of ADHD medications are approved in adults, there are fewer approved formulations for adults than for children. Efficacy in adults is more subjective than in children, which may affect how efficacy rates for adult treatments are calculated. Adults also present a greater diversion risk than children. In addition, there are several new and emerging medication treatments worth considering.

This Expert Roundtable Supplement represents part 2 of a 3-part supplement series on adult ADHD led by Lenard A. Adler, MD. In this activity, Thomas J. Spencer, MD, discusses the neurobiology and genetics of adult ADHD; Mark A. Stein, PhD, discusses stimulant therapy; and Jeffrey H. Newcorn, MD, reviews nonstimulants and psychosocial treatments
The Medical Treatment of Obsessive-Compulsive Disorder and Anxiety
Authors: Bandelow Borwin
Published: August 2016

Selective serotonin reuptake inhibitors (SSRIs) are first-line pharmacotherapy treatments for obsessive-compulsive disorder (OCD). Clomipramine is effective in OCD but associated with more adverse events. Typically, higher doses of antidepressants are required for OCD. Up to 50% of patients do not respond to initial treatment of OCD. Treatment options for nonresponders include augmentation of antidepressants with atypical antipsychotics, among other strategies. First-line treatments for anxiety disorders include SSRIs, serotonin norepinephrine reuptake inhibitors, and pregabalin. Tricyclic antidepressants are equally effective as SSRIs, but are less well tolerated. In treatment-resistant cases, benzodiazepines may be used when the patient does not have a history of dependency and tolerance. Other treatment options include irreversible and reversible monoamine oxidase inhibitors, the atypical antipsychotic quetiapine, and other medications. Cognitive-behavioral therapy has been sufficiently investigated in controlled studies of OCD and anxiety disorders and is recommended alone or in combination with the above medications.
Self-Help and Internet-Guided Interventions in Depression and Anxiety Disorders: A Systematic Review of Meta-Analyses
Authors: Hof Edith van‘t , Cuijpers Pim , Stein Dan J.
Published: August 2016

There is a growing database of research on self-help and Internet-guided interventions in the treatment of common mental disorders, and a number of meta-analyses have now been published. This article provides a systematic review of meta-analyses on the efficacy of self-help interventions, including Internet-guided therapy, for depression and anxiety disorders. Searches were conducted in PubMed, PsychINFO, EMBASE, and the Cochrane database for statistical meta-analyses of randomized, controlled trials of self-help or Internet-guided interventions for depression or anxiety disorders published in English. Reference lists were also used to find additional studies. Effect sizes were tabulated; 13 meta-analyses reported medium to large effect sizes for self-help interventions. Studies included in the meta-analyses differed in samples, type of self-help (eg, computer-aided, Internet-guided), control conditions, and study design. The meta-analyses indicate that self-help methods are effective in a range of different disorders, including depression and anxiety disorders. Most meta-analyses found relatively large effect sizes for self-help treatments, independent of the type of self-help, and comparable to effect sizes for face-to-face treatments. However, further research is needed to optimize the use of self-help methods.
The Role of Non-Pharmacologic Approaches in the Management of Fibromyalgia
Authors: Williams David A.
Published: August 2016

The optimal management of fibromyalgia (FM) is comprised of both pharmacologic and nonpharmacologic approaches. This multidimensional approach is preferred given that FM is not only a pain condition, but involves a number of other symptoms as is reflected in the new clinical criteria being developed by Wolfe and colleagues. Proper management of FM should be informed through multidimensional assessment of the clinically relevant domains described previously in this supplement. Pharmacologic and nonpharmacologic approaches work together to provide the broadest possible coverage of these domains, minimize the impact of each domain on functioning and well-being, and facilitate long-term adaptations to one's lifestyle.

The use of nonpharmacologic strategies in the management of FM has varying levels of evidence. The strongest evidence currently exists for aerobic exercise, cognitive-behavioral therapy (CBT), and for patient education or self-management. Moderate evidence exists for strength training, acupuncture, hypnotherapy, and biofeedback modalities. Weaker evidence exists for manual massage therapy. Currently, there is no evidence of long-term benefit for tender point injections or flexibility exercise modalities, although these options may be beneficial in the short term. This article will focus on the three areas that have the strongest evidence base: patient education, exercise, and CBT.

Educational programs are typically offered in the context of primary care or in specialty practices. In their simplest form, these programs try to dispel myths about FM and provide patients with the most up-to-date knowledge about the condition.
Comparing Expenditures in Depressed Patients Treated with Venlafaxine ER and SSRIs
Authors: Sloan Diane M. , LeLorier Jacques
Published: August 2016

Depression is a chronic illness whose true costs to society are unclear. The costs associated with depression are direct (drugs and treatment), indirect (absenteeism and loss of productivity), and intangible (quality of life). Direct costs are usually easy to quantify. Indirect costs often test the ingenuity of researchers whose results are, at best, crude approximations. Intangible costs are elusive and may never be measured with any degree of accuracy. To compound matters further, many patients with depression have never been diagnosed, which complicates the cost accounting analysis of depression from a societal perspective. What is clear is that the worldwide costs of depression are climbing The overall costs of treating depression attributable to drug therapy are modest. The appropriate choice of antidepressant therapy is likely to be the product that provides the highest effectiveness in terms of overall costs. As a result, it is important that prescribers have an idea of the benefit derived from the cost of drugs, and how the cost effectiveness of different drugs compare.

Previous studies of antidepressant cost effectiveness have suggested that the use of venlafaxine, which costs more than generic selective serotonin reuptake inhibitors (SSRIs), may be no more costly when total costs (eg, how many drugs were prescribed, how many medical or emergency room visits patients had, and how often they were hospitalized) are calculated. The objectives of this retrospective, populationbased, database study were to identify patient characteristics and factors associated with the choice of antidepressant in order to assess differences in persistence, healthcare utilization, and direct medical costs associated with venlafaxine and SSRI pharmacotherapy.

Study results indicated that in this real-world setting, medical costs were similar among depressive patients treated with venlafaxine and SSRIs. The higher purchase price of venlafaxine was balanced by cost savings due to fewer hospitalizations and fewer outpatient medical visits. Differences in drug treatment may also partially explicate the observed differences in average direct medical costs between venlafaxine and SSRIs.
Recognizing and Effectively Treating Depression
Authors: Lecrubier Yves
Published: August 2016

In 2004, more people died in Europe from suicide than from road accidents. The lifetime prevalence of major depression is 20% for women and 10% for men. Depression is a leading cause of disability and decreased quality of life. In spite of this, numerous studies have shown that only ~50% of depressed patients are recognized as such in primary care. In a recent international survey of everyday management of depression we observed that only ~15% of patients became symptom-free following treatment. In spite of this low level of remission primary care physicians and psychiatrist only rarely increased the dose of antidepressant or switched to another medication as unanimously recommended by different guidelines. Numerous studies have demonstrated the importance of maintaining treatment for ≥6 months after remission is obtained in order to prevent relapse and recurrence. However, a recent study reported that only 19% of a cohort of patients in primary care continued treatment for 6 months as recommended. Antidepressants can be very effective but only when used correctly at adequate doses and for a sufficient duration. Although new improved antidepressants are obviously desirable, a greater recognition of depression and its treatment by the correct use of currently available antidepressant drugs could greatly improve the management of this major public health problem.
Treatment of Excessive Daytime Sleepiness
Authors: O'Malley Mary B.
Published: August 2016

The most common cause of sleepiness is sleep deprivation, which is often due to behaviorally induced sleep limitations. One method of preventing impaired or shortened sleep is to ensure good sleep hygiene. It is important to review with patients the principles of sleep hygiene so that they can rule out causal behaviors that might be relatively simple to correct. Principles of good sleep hygiene include maintaining a regular sleep/wake schedule, exposure to light in the morning hours, avoiding caffeine and nicotine especially 4–6 hours before bedtime, avoiding alcohol and heavy meals before sleep, regular exercise (vigorous exercise should be avoided 3–4 hours before sleep), limiting time in bed to the time spent sleeping, and allowing sufficient time to get comfortable and relaxed prior to sleep. Even if one can fall asleep after drinking alcohol or caffeine, sleep maintenance can be curtailed. Sensitivity to these stimulants is often apparent in the latter half of the night. People often fail to recognize that vigorous aerobic workouts close to bedtime makes it harder to fall asleep. This is because a revved up metabolism heats the body up, and thereby delays the normal cooling of the core body temperature which triggers the onset of sleep.

One study assessed the sleep of 259 subjects using the Multiple Sleep Latency Test (MSLT), an objective measure of daytime sleepiness that assesses how quickly someone can fall asleep in conducive conditions. The results indicated that many people in the general population carry a very heavy burden of sleepiness (Slide 1). Many physicians were shown to carry pathological levels of sleepiness because of their heavy call schedules and their foreshortened sleep on nights that they are not on call. The average adult needs 8.2 hours of sleep per night, and not surprisingly many studies have found that the sleepiest adults spent ≤6 hours in bed. What makes matters worse is that insight into the impairments of sleepiness erodes rapidly, but other cognitive and somatic impairments continue to mount with regular chronic under-sleeping. When sleepiness is due to chronic sleep deprivation, treatment often consists of scheduling enough time in bed to allow for an adequate amount of sleep.
The Spectrum of Recurrent Thoughts and Behaviors in Frontotemporal Dementia
Authors: Mendez Mario F. , Shapira Jill S.
Published: August 2016

This article describes the spectrum of recurrent thoughts and behaviors that can result from frontotemporal dementia (FTD) and its variants. Although repetitive behaviors can result from a range of brain disorders, FTD is the most common neurologic cause of new-onset recurrent thoughts and behaviors in middle or late life. Patients with FTD can manifest typical or bizarre compulsions, hoarding, verbal and motor stereotypies and complex tics; self-injurious acts, perseverations; and fixed, obsessional thoughts. The frequency and variability of these repetitive behaviors suggest a common disturbance of orbitofrontal-basal ganglia circuits involved in response inhibition. The amelioration of these recurrent events with the administration of serotonin selective reuptake inhibitors further suggests a serotonergic deficit.
Prevalence of Bipolar Depression
Authors: Post Robert M.
Published: August 2016

Recent data indicate that bipolar illness is underdiagnosed and therefore undertreated in the community (Slide 1). A recent survey of >85,000 households in the United States found a 3.7% positive screen for prominent bipolar symptomatology. Using the Mood Disorder Questionnaire, which has good specificity and sensitivity in outpatient clinics, the study also found that the prevalence was higher, 9.3%, among patients 18–24 years of age. However, most disappointing was that only 20% of the positive screens were diagnosed as bipolar, and among those, most were not treated with mood stabilizers. In addition, 31% of patients had been diagnosed with unipolar depression. Several studies have shown that approximately 20% to 40% of presumptively unipolar patients actually have bipolar II or bipolar disorder not otherwise specified. Combined, the data show that bipolar disorder, bipolar depression in particular, is highly prevalent and often misdiagnosed or unrecognized.

Two recent studies found virtually the same data showing that depression is the predominant problem in naturalistically treated bipolar outpatients. Judd and colleagues found that depression was three times more prevalent than mania in bipolar patients. This is exactly what was found in the Stanley Foundation bipolar outpatient follow-up study, which rated the study's first 258 patients every day for 1 year (Slide 2). The study found that patients were ill almost 50% of the time; they were depressed 33% of the days in the year, and hypomanic or manic 10.8% of the days. This occurred despite aggressive treatment with a variety of agents, such as mood stabilizers, antidepressants, and benzodiazepines in 50% of the patients, and typical or atypical neuroleptics in almost 50% of the patients. Thus, even bipolar patients who are intensively treated in academic settings have a very substantial degree of morbidity, particularly depression.
Antidepressant Effect of Mood Stabilizers
Authors: Baldassano Claudia F.
Published: August 2016

Bipolar depression certainly poses the greatest challenge to clinicians treating bipolar patients. Having a widespread disability associated with it, bipolar depression is often chronic, is less responsive to medication treatment, and has a particularly high rate of suicide. There are currently no drugs approved by the Food and Drug Administration for the treatment of bipolar depression, although full trials have been conducted with lithium, the antipsychotic olan-zapine, and the antiepileptic (AED) lamotrigine. Data for the other AEDs are quite limited and not controlled. The American Psychiatric Association guidelines recommends maximizing the dose in patients who are already on a mood stabilizer and initiating lithium or lamotrigine in patients who are not on a mood stabilizer.

Zornberg and Pope reviewed nine studies comparing lithium to placebo in bipolar depression. Among the 145 patients in these studies, there was detectable response in 79% and an unequivocal response in 36%. Although the studies varied in their methodological design and rigor, they argue quite strongly that lithium is an effective anti-depressant. In addition, six of the seven pre1990 studies evaluating lithium for bipolar depression indicated that the drug had significant antidepressant effects.

The most recent study of lithium for bipolar depression randomly assigned 117 outpatients with acute bipolar depression to treatment with either placebo, Imipramine, or paroxetine. At the 10-week study endpoint, lithium monotherapy was as effective as the addition of an antidepressant, suggesting lithium's antidepressant properties.
Aspetti psicosociali delle condotte suicidarie in Italia. Un'analisi trasversale e multivariata su dati aggregati
Authors: Crepet Paolo , Micciolo Rocco
Published: August 2016

Objective- To analyse suicide trends in Italy and to correlate suicide rates with psychosocial indicators.Design- Cross-sectional analysis of aggregate data at national level (1960-1990).Setting- Italy.Main outcome measures- Mortality rates (deaths for suicide, mental disorders and homicide), hospital admission rates (for schizophrenia, neurosis and affective psychosis), unemployment rates, alcohol consumption. Principal components of the correlation matrix calculated on the psychosocial indicators.Results- The study indicates that a slight increate in suicide rates has been recorded among males (+10,7%) but not among females. The regions with the highest suicide rate are the Northern ones (up to twice the national average). The age groups with the highest suicide risk are those over 70 years. In females and males over 65 between 1974 and 1989 the suicide rate rose by 70% and 77% respectively. Between 1978 and 1989, the suicide rate among the people in search of a first job rose by 25%, among the employed it rose by 35%, while among the people in search of a new job it rose by 594%. Correlation between admission and suicide rates shows negative figure both for affective psychosis and neurosis, wherelse the correlation with schizophrenia is positive. The correlation with death both by mental disorders and homicide is positive. The correlation with death both by mental disorders and homicide is positive. The correlation between suicide and alcohol consumption is negative, while that with unemployment is positive. Principal components analysis showed a first component, wich explained more then 60% of the general variation, highly correlated with suicide rates.
Interventi psicoterapici nei dipartimenti di salute mentale di Napoli: un'indagine sulle scelte e sulla qualificazione degli operatori
Authors: Morlino Massimo , Martucci Giuseppe , Amendola Davide , Muscettola Giovanni
Published: August 2016

Objective - To survey and analyse the extent of utilization of «Non Pharmacological Interventions» (NPI) in the public mental health services of a large city. Setting - Inteview of the entire medical staff employed in 1991 in 10 Departments of Mental Health in the urban area of Naples, Italy. Main measures - A «ad hoc» questionnaire was prepared to gather informations on prevalence of use on NPI in different therapeutic settings, the selected technique according to the different diagnostic categories and the degree of professional training of the interviewed medical personnel. Result - The NPI, as the only treatment, was preferred by the large majority (86%) of the medical staff. The patients treated with NPI was double in outpatient than in inpatient. Although the medical staff did not use the same diagnostic criteria (ICD-9, DSM-III, others) anxiety (49%) and personality disorders (14,3%) were the diagnostic categories most commonly selected for NPI. At the time of the survey 24% of the patients were treated with psychotherapy. Support psychoterapy, psychoanalysis, family therapy were the most frequently employed. The support psychotherapy was mainly used in treatment of schizophrenia. Near to 50% of the medical staff reported a combined use of up to five different NPI. By and large choice of NPI was found dependent on the type of training and inversly correlated with the degree of seniority. Conclusions - The data obteined from the present survey show the large use and variability in NPI employed in public mental health services. The analysis of psycotherapy used suggests a different approach between public and private sector.
Prevalenza dei disturbi affettivi (DSM-IIIR) nei pazienti di un reparto di medicina geriatrica. Uno studio epidemiologico con controlli della popolazione generale
Authors: Turrina Cesare , Steinmayr Maria , Piasere Orazio , Siciliani Orazio
Published: August 2016

Objective - To investigate the rate of DSM-IIIR main affective disorders in a sample (52) of elderly medical patients consecutively admitted to a geriatric ward; to look for risk factors associated with depression; to compare the rate of depression with the one detected in community controls (117 subjects). Design - All consecutive patients admitted during January-February 1990 were assessed with a standardized psychiatric interview (Geriatric Mental State Examination) and with the Mini-Mental State Examination. Setting - The IV Geriatric Division (ward and day-hospital), Ospedale Civile Maggiore of Verona, which cares for elderly affected by medical illnesses. Main outcome measures - Depression was diagnosed according to the main DSM-IIIR categories for mood disorders. Results - Overall, an affective disorder was diagnose in 25% of the subjects (major depression 5,7%, dysthymic disorder 3,8%, n.o.s. depression 13,4%, adjustment disorder with depressive mood 1,9%). This rate was significantly higher when compared with the prevalence detected in community controls (25% vs. 11,1%). Older age, female sex, physical disability and distressing events were not associated with affective illness, while the lack of social support was significantly associated with depression. Conclusions - Elderly medical patients turned out to be an high risk group for depression, which deserves psychiatric screening and specific treatment.
Epidemiologia e psichiatria: considerazioni di metodo
Authors: Vineis Paolo
Published: August 2016

Psychiatry has been, among medical disciplines, the one showing the highest conflict between a «positivist» model and the «hermeneutic» tradition. In particular, in recent years several authors have suggested that both the scientific method and a scientific mentality should be introduced in psychiatric practice and research. They claim that criteria like a strong correlation among clearly defined signs and symptoms, a high predictive value towards the outcome and therapeutical response, and a clearly defined relationship between the symptoms and etiology are necessary to accept a diagnositc entity. Since in the case of e.g. schizofrenia such requirements are not met, some authors even suggest that the concept of schizofrenia should be abandoned. The present paper aims to show that such problems are not unique to mental disease, but are common to several branches of medicine. For example, the definition and classification of cancer follow a «polythetic» criterion which is similar to the concept of «family resemblances». Also, diagnostic reproducibility is often low in other medical disciplines. The paper examines how such methodological problems could be dealt with using the tools of epidemiology.
Self-Compassion: Evaluation of a Psychoeducational Website – CORRIGENDUM
Authors: Talbot France , Thériault Judith , French Douglas J.
Published: August 2016

Please note that the self-compassion Website (www.self-compassion.org) and the Mindfulness Self-Compassion program (MSC) offer some similar self-compassion and guided meditation exercises, but differ in structure and content. As currently described on www.CenterforMSC.org, MSC is an 8-week empirically-supported program targeting non-clinical populations. It is offered in a group format and is not led by therapists necessarily. MSC is not considered by the authors as a form of group therapy. As such, ‘resource-building course’ should have been used in the original paper in lieu of ‘group therapy’.
Beurteilung von Kindern und Jugendlichen in Erziehungshilfen mit dem Kompetenzanalyseverfahren (KANN)
Authors: Suing Martina , Brochhagen-Beier Birgit Maria , Gollan Tobias , Petermann Franz , Waldmann Hans-Christian , Schmidt Martin H. , Sinzig Judith
Published: August 2016

Zusammenfassung. Das Kompetenzanalyseverfahren (KANN) ist ein Fremdbeurteilungsverfahren für Eltern und pädagogische Fachkräfte zur Beurteilung beobachtbarer Kompetenzen von Kindern und Jugendlichen. In der Studie wird untersucht, ob, und wenn ja, inwiefern sich die Unterschiede zwischen den zwei Normstichproben (Schulnorm/Elternurteil vs. Kinder- und Jugendhilfe-Norm/Urteil pädagogischer Fachkräfte) durch (1) die Reliabilität des Messinstruments, (2) systematische Beurteilertendenzen und/oder (3) Kompetenzdefizite von Kindern und Jugendlichen in Erziehungshilfen erklären lassen. Hierzu wurden die Intra-/Interrater-Reliabilität und -Übereinstimmung an vier Stichproben aus dem Bereich der Erziehungshilfen analysiert: (A) Pädagoge/-in A – A (Test-Retest), n = 153; (B) Pädagoge/-in A – B, n = 169; (C) Mutter–Vater, n = 26 und (D) Pädagoge/-in – Elternteil, n = 136. Die Ergebnisse weisen auf eine gute Intra-/Interrater-Reliabilität und eine akzeptable Übereinstimmung im Urteil pädagogischer Fachkräfte hin. Zwischen unterschiedlichen Beurteilertypen (Pädagoge/-in – Elternteil), lässt sich eine deutlich niedrigere Interrater-Reliabilität und -Übereinstimmung feststellen. Der Vergleich des Elternurteils mit den beiden Normstichproben verdeutlicht die unterdurchschnittlichen KANN-Werte von Kindern und Jugendlichen in Erziehungshilfen. Eine Überschätzungstendenz der Eltern ist wahrscheinlich.
Konzentrationsdiagnostik bei Grundschulkindern
Authors: Brunnemann Nicole , Sparfeldt Jörn R.
Published: August 2016

Zusammenfassung. Konzentration gilt als bedeutsames Korrelat und als Prädiktor erfolgreichen Lern- und Arbeitsverhaltens. Insbesondere bei Grundschulkindern wurde wiederholt die Güte entsprechender Testverfahren bezweifelt. Zur psychometrischen Prüfung bearbeiteten Viertklässlerinnen und Viertklässler (N = 530) drei Testverfahren: (a) die Testreihe zur Prüfung der Konzentrationsfähigkeit (TPK; Kurth & Büttner, 1999 ) mit schulnäheren Aufgaben (Abschreibtext, einfache Rechenaufgaben, Merkaufgabe) sowie – mit schulferneren Aufgaben – (b) den Aufmerksamkeits- und Konzentrationstest (d2-R; Brickenkamp, Schmidt-Atzert & Liepmann, 2010 ), einen Durchstreichtest, und (c) den Zahlen-Verbindungs-Test (ZVT; Oswald & Roth, 1978 ). Zusätzlich schätzten Klassenlehrkräfte (N = 31) die Konzentrationsleistung der Kinder ein. Die psychometrischen Manualkennwerte wurden weitgehend repliziert. Konzentrationsleistungskennwerte innerhalb und zwischen Tests korrelierten moderat, konfirmatorisch zeigte ein Generalfaktor eine gute Modellpassung. Die von den Lehrkräften und Schulkindern eingeschätzten Konzentrationsleistungen korrelierten moderat mit der Testleistung in schulnäheren und niedriger in schulferneren Aufgaben. Die Befunde werden vor dem Hintergrund einer konstruktvaliden Konzentrationsdiagnostik diskutiert.
Metal stressors consistently modulate bacterial conjugal plasmid uptake potential in a phylogenetically conserved manner
Authors: Klümper Uli , Dechesne Arnaud , Riber Leise , Brandt Kristian K , Gülay Arda , Sørensen Søren J , Smets Barth F
Published: August 2016

The environmental stimulants and inhibitors of conjugal plasmid transfer in microbial communities are poorly understood. Specifically, it is not known whether exposure to stressors may cause a community to alter its plasmid uptake ability. We assessed whether metals (Cu, Cd, Ni, Zn) and one metalloid (As), at concentrations causing partial growth inhibition, modulate community permissiveness (that is, uptake ability) against a broad-host-range IncP-type plasmid (pKJK5). Cells were extracted from an agricultural soil as recipient community and a cultivation-minimal filter mating assay was conducted with an exogenous E. coli donor strain. The donor hosted a gfp-tagged pKJK5 derivative from which conjugation events could be microscopically quantified and transconjugants isolated and phylogenetically described at high resolution via FACS and 16S rRNA amplicon sequencing. Metal stress consistently decreased plasmid transfer frequencies to the community, while the transconjugal pool richness remained unaffected with OTUs belonging to 12 bacterial phyla. The taxonomic composition of the transconjugal pools was distinct from their respective recipient communities and clustered dependent on the stress type and dose. However, for certain OTUs, stress increased or decreased permissiveness by more than 1000-fold and this response was typically correlated across different metals and doses. The response to some stresses was, in addition, phylogenetically conserved. This is the first demonstration that community permissiveness is sensitive to metal(loid) stress in a manner that is both partially consistent across stressors and phylogenetically conserved.
Identification of disease-specific motifs in the antibody specificity repertoire via next-generation sequencing
Authors: Pantazes Robert J. , Reifert Jack , Bozekowski Joel , Ibsen Kelly N. , Murray Joseph A. , Daugherty Patrick S.
Published: August 2016

Disease-specific antibodies can serve as highly effective biomarkers but have been identified for only a relatively small number of autoimmune diseases. A method was developed to identify disease-specific binding motifs through integration of bacterial display peptide library screening, next-generation sequencing (NGS) and computational analysis. Antibody specificity repertoires were determined by identifying bound peptide library members for each specimen using cell sorting and performing NGS. A computational algorithm, termed Identifying Motifs Using Next- generation sequencing Experiments (IMUNE), was developed and applied to discover disease- and healthy control-specific motifs. IMUNE performs comprehensive pattern searches, identifies patterns statistically enriched in the disease or control groups and clusters the patterns to generate motifs. Using celiac disease sera as a discovery set, IMUNE identified a consensus motif (QPEQPF[PS]E) with high diagnostic sensitivity and specificity in a validation sera set, in addition to novel motifs. Peptide display and sequencing (Display-Seq) coupled with IMUNE analysis may thus be useful to characterize antibody repertoires and identify disease-specific antibody epitopes and biomarkers.
Comparison of CT and MRI in Diagnosis of Laryngeal Carcinoma with Anterior Vocal Commissure Involvement
Authors: Wu Jian-hui , Zhao Jing , Li Zeng-hong , Yang Wei-qiang , Liu Qi-hong , Yang Zhi-yun , Liao Bing , Li Xiao-ling , Wang Bin , Qin Hao , Luo Jie , Lv Ke-xing , Wen Wei-ping , Lei Wen-bin
Published: August 2016

This study aimed to compare the accuracy of CT and MRI in determining the invasion of thyroid cartilage by and the T staging of laryngeal carcinoma with anterior vocal commissure (AVC) involvement. A total of 26 cases of laryngeal carcinomas with AVC involvement from May 2012 to January 2014 underwent enhanced CT and MRI scan, out of whom 6 patients also underwent diffusion-weighted magnetic resonance imaging(DWI). T staging and thyroid cartilage involvement were evaluated. All the surgical specimens underwent serial section and were reviewed by two senior pathologists independently. When compared with pathologic staging, the accuracy was 88.46% (23/26) of MRI scan (with a 95% confidence interval 37~77%) and 57.69% (15/26) of CT scan (with a 95% confidence interval 70~98%), respectively (P < 0.01). We also reported three cases who were misdiagnosed on CT or MRI about either the thyroid cartilage was involved or not, and one case of preliminary study of DWI. Compared to CT, MRI exhibited a higher accuracy rate on T staging of laryngeal carcinomas with AVC involvement. Combined utility of CT and MRI could help improve the accuracy of assessment of thyroid cartilage involvement and T staging of laryngeal carcinomas with AVC involvement.
CCN concentrations and BC warming influenced by maritime ship emitted aerosol plumes over southern Bay of Bengal
Authors: Ramana M. V. , Devi Archana
Published: August 2016

Significant quantities of carbon soot aerosols are emitted into pristine parts of the atmosphere by marine shipping. Soot impacts the radiative balance of the Earth-atmosphere system by absorbing solar-terrestrial radiation and modifies the microphysical properties of clouds. Here we examined the impact of black carbon (BC) on net warming during monsoon season over southern Bay-of-Bengal, using surface and satellite measurements of aerosol plumes from shipping. Shipping plumes had enhanced the BC concentrations by a factor of four around the shipping lane and exerted a strong positive influence on net warming. Compiling all the data, we show that BC atmospheric heating rates for relatively-clean and polluted-shipping corridor locations to be 0.06 and 0.16 K/day respectively within the surface layer. Emissions from maritime ships had directly heated the lower troposphere by two-and-half times and created a gradient of around 0.1 K/day on either side of the shipping corridor. Furthermore, we show that ship emitted aerosol plumes were responsible for increase in the concentration of cloud condensation nuclei (CCN) by an order of magnitude that of clean air. The effects seen here may have significant impact on the monsoonal activity over Bay-of-Bengal and implications for climate change mitigation strategies.
Immunogenicity and functional characterization of Leishmania-derived hepatitis C virus envelope glycoprotein complex
Authors: Grzyb Katarzyna , Czarnota Anna , Brzozowska Agnieszka , Cieślik Anna , Rąbalski Łukasz , Tyborowska Jolanta , Bieńkowska-Szewczyk Krystyna
Published: August 2016

Hepatitis C virus (HCV) envelope glycoproteins E1 and E2 are the main inducers of a cross-neutralizing antibody response which plays an important role in the early phase of viral infection. Correctly folded and immunologically active E1E2 complex can be expressed in mammalian cells, though the production process might still prove restrictive, even if the immunological response of a vaccine candidate is positive. Here, we report a characterization and immunogenicity study of a full-length (fE1E2) and soluble version of the E1E2 complex (tE1E2) from genotype 1a, successfully expressed in the cells of Leishmania tarentolae. In a functional study, we confirmed the binding of both Leishmania-derived E1E2 complexes to the CD-81 receptor and the presence of the major epitopes participating in a neutralizing antibody response. Both complexes were proved to be highly immunogenic in mice and elicited neutralizing antibody response. Moreover, cross-reactivity of the mouse sera was detected for all tested HCV genotypes with the highest signal intensity observed for genotypes 1a, 1b, 5 and 6. Since the development of a prophylactic vaccine against HCV is still needed to control the global infection, our Leishmania-derived E1E2 glycoproteins could be considered a potential cost-effective vaccine candidate.
A likely inverse-Compton emission from the Type IIb SN 2013df
Authors: Li K. L. , Kong A. K. H.
Published: August 2016

The inverse-Compton X-ray emission model for supernovae has been well established to explain the X-ray properties of many supernovae for over 30 years. However, no observational case has yet been found to connect the X-rays with the optical lights as they should be. Here, we report the discovery of a hard X-ray source that is associated with a Type II-b supernova. Simultaneous emission enhancements have been found in both the X-ray and optical light curves twenty days after the supernova explosion. While the enhanced X-rays are likely dominated by inverse-Compton scatterings of the supernova’s lights from the Type II-b secondary peak, we propose a scenario of a high-speed supernova ejecta colliding with a low-density pre-supernova stellar wind that produces an optically thin and high-temperature electron gas for the Comptonization. The inferred stellar wind mass-loss rate is consistent with that of the supernova progenitor candidate as a yellow supergiant detected by the Hubble Space Telescope, providing an independent proof for the progenitor. This is also new evidence of the inverse-Compton emission during the early phase of a supernova.
Towards coherent combining of X-band high power microwaves: phase-locked long pulse radiations by a relativistic triaxial klystron amplifier
Authors: Ju Jinchuan , Zhang Jun , Qi Zumin , Yang Jianhua , Shu Ting , Zhang Jiande , Zhong Huihuang
Published: August 2016

The radio-frequency breakdown due to ultrahigh electric field strength essentially limits power handling capability of an individual high power microwave (HPM) generator and this issue becomes more challenging for high frequency bands. Coherent power combining therefore provides an alternative approach to achieve an equivalent peak power of the order of ∼100 GW, which consequently provides opportunities to explore microwave related physics at extremes. The triaxial klystron amplifier (TKA) is a promising candidate for coherent power combing in high frequency bands owing to its intrinsic merit of high power capacity, nevertheless phase-locked long pulse radiation from TKA has not yet been obtained experimentally as the coaxial structure of TKA can easily lead to self-excitation of parasitic modes. In this paper, we present investigations into an X-band TKA capable of producing 1.1 GW HPMs with pulse duration of about 103 ns at the frequency of 9.375 GHz in experiment. Furthermore, the shot-to-shot fluctuation standard deviation of the phase shifts between the input and output microwaves is demonstrated to be less than 10°. The reported achievements open up prospects for accomplishing coherent power combining of X-band HPMs in the near future and might also excite new development interests concerning high frequency TKAs.