bluuebunny/crossref_metadata_2025 huggingface dataset:
Conclusion
Authors: Sullivan Maria A.
Published: September 2016

Addiction in older adults very often goes unrecognized, for several reasons: social biases about the elderly, age-related metabolic changes, and the inappropriate use of prescription benzodiazepines and opioids to address untreated anxiety and mood conditions. Alcohol or substance-use disorders (SUDs) in older individuals may present in subtle and atypical ways. Strategies to overcome such difficulties include systematic screening using validated instruments, patient education regarding the impact of psychoactive substances on health, and cautious prescribing practices. Relying on standard DSM criteria may result in a failure to detect an SUD that presents with cognitive symptoms or physical injury, as well as the absence of work or social consequences. Older individuals can benefit from the application of risk-stratification measures, and they can be referred, e.g., to age-appropriate group therapy and non-confrontational individual therapy focusing on late-life issues of loss and sources of social support, as well as be offered medication management for alcohol or substance use disorder. Although research has been limited in this population, treatment outcomes have been found to be superior in older adults than younger adults.
Introduction to acute medicine
Authors: Leach Dr Richard , Bell Professor Derek , Moore Professor Kevin
Published: September 2016

Chapter 1 provides an introduction to acute medicine, and discusses aspects relevant to the initial, acute management phase, including recognizing and assessing the acutely unwell patient, organization of acute medical admission wards, admission and discharge guidelines, general supportive care, severity of illness scoring systems, the hypotensive patient and shock, the blue and breathless (cyanosed) patient, the oliguric patient, the confused/disorientated/‘obtunded’ patient, and the ongoing management of acutely ill patient.
Disorders due to physical agents
Authors: Brett Dr Stephen , Brett Dr Andrew , Leach Dr Richard , Leach Dr Richard , Patterson Dr Caroline
Published: September 2016

Chapter 18 discusses disorders due to physical agents, including trauma, thermal burns, toxic inhalation injury, electrical and chemical injury, thermal disorders, allergy and anaphylaxis, envenomation, stings, and bites, and fitness to fly and effects of altitude.
Ethics and end of life issues
Authors: Leach Dr Richard
Published: September 2016

Chapter 22 discusses ethics and end of life issues as they relate to acutely-unwell patients.
Respiratory diseases and respiratory failure
Authors: Millar Professor Ann B , Leach Dr Richard , Preston Dr Rebecca , Leach Dr Richard , Leach Dr Richard , Lim Dr Wei Shen , Leach Dr Richard , Breen Dr Ronan , Leach Dr Richard , Higgins Dr Bernard , Leach Dr Richard , Cooper Professor Chris , Halpin Professor David , Leach Dr Richard , Hooper Dr Clare , Spiro Professor Stephen , Leach Dr Richard , Harvey Dr John , Leach Dr Richard , Light Professor Richard , Stewart Dr Alaisdair , Leach Dr Richard , Ahmed Dr Liju , Ahmed Dr Liju , Stewart Dr Alaisdair , Leach Dr Richard , Chua Dr Felix , Leach Dr Richard , Spiteri Professor Monica , Leach Dr Richard , Peacock Professor Andrew , Morice Professor Alyn , Leach Dr Richard , D’Cruz Professor David , Leach Dr Richard , Williams Professor Adrian J , Leach Dr Richard
Published: September 2016

Chapter 5 covers respiratory diseases and respiratory failure, including clinical presentations of respiratory disease, assessment of diffuse lung disease, hypoxaemia, respiratory failure, and oxygen therapy, pneumonia, mycobacterial infection, asthma, chronic obstructive pulmonary disease (COPD), lung cancer, mediastinal lesions, pneumothorax, pleural disease, asbestos-related lung disease, diffuse parenchymal (interstitial) lung disease, sarcoidosis, pulmonary hypertension, acute respiratory distress syndrome, bronchiectasis and cystic fibrosis, bronchiolitis, eosinophilic lung disease, airways obstruction, aspiration syndromes, and near-drowning, pulmonary vasculitis, the immunocompromised host, sleep apnoea, and rare pulmonary diseases.
Neurological diseases and emergencies
Authors: Howard Dr Robin , Andrews Dr Thomasin C , Howard Dr Robin , Holmes Dr Paul , Howard Dr Robin , Koutroumanidis Professor Michael , Koutroumanidis Professor Michael , Howard Dr Robin
Published: September 2016

Chapter 7 discusses neurological diseases and emergencies, including headache, transient loss of consciousness, states of impaired consciousness, the dementias, gait and disturbances of speech, stroke, neuro-ophthalmology, epilepsies and epileptic states, status epilepticus in adults, infections of the nervous system, demyelinating diseases, neuromuscular disease, movement disorders (disorders of the extrapyramidal system), neuro-oncology, cranial nerve disorders, spinal cord lesions, and toxic and nutritional disease.
Theorizing defiance
Authors: Potter Nancy Nyquist
Published: September 2016

This chapter presents a general theory of defiance, both in general terms and as it pertains to patients with mental disorders. The author frames defiance as a response to authoritative norms for civility and argues that these norms are, and often should be, questioned by those who are systemically adversely affected by them. Defiance is distinguished from civil disobedience, civil resistance, and other challenges to authority. Aristotle’s virtue ethics is introduced, but with challenges to his neglect of oppressive or disabling conditions on the ability to flourish. The concept of master narratives is used to identify ways that dominant norms for reasoning make it difficult to assess properly when defiance is virtuous, vicious, or a symptom of mental illness. Examples are employed to illustrate what would count as a deficiency, an excess, and the mean. The author also introduces the framework of burdened virtues—virtues that impede flourishing and that do harm to those who develop them.
The virtue of giving uptake in psychiatry
Authors: Potter Nancy Nyquist
Published: September 2016

This chapter focuses on ethical and epistemological issues that provide some direction in engaging well with defiant behavior, drawing upon Austin’s theory of speech acts to introduce the author’s theory that giving uptake is a virtue. This virtue is not the only one that can be useful in responding to defiance, but giving uptake is especially valuable and it is important for psychiatrists to be aware of it. The author considers epistemic impediments to giving uptake properly. A social epistemology is employed to make the connection between knowing well and being an ethical psychiatrist. It is argued that the kind of problems that occur in psychiatric practice can affect even well-intended and conscientious psychiatrists’ disposition to give uptake well and, in particular, to people who behave defiantly. The author works through a case-study of Borderline Personality Disorder (BPD) and offers a hypothetical case for how idealized psychiatric engagement would look.
Hyperinsulinemic Hypoglycemia
Authors: Arnoux Jean-Baptiste , de Lonlay Pascal
Published: September 2016

Hypoglycemia is a frequent and often overlooked symptom. Indeed, most cases are related to insulin therapy in diabetic patients, to hormone deficiencies, or to very prolonged fasts. In other cases, however, unusual findings (unexplained hypoglycemia, especially if clinically severe, recurrent, postprandial, or in typical relationship to external factors such as food ingestion or exercise, or associated with hepatomegaly) should lead to a careful clinical and biological evaluation. Hyperinsulinemic hypoglycemia is a dysregulation of the glucose-induced insulin secretion. Besides insulinoma and genetic defects of the pancreatic ß-cell (congenital hyperinsulinism, CHI), some other pathophysiological mechanisms can lead to hypoglycemia with biological evidence for an involvement of the insulin signaling pathway (insulin-like substances, autoimmunity, and other).
Coenzyme Q10 Deficiency
Authors: Rahman Shamima , Janssen Mirian C. H.
Published: September 2016

Primary CoQ10 deficiencies are usually diagnosed in childhood, but late-onset forms are recognized. The expression of all clinical symptoms is extremely variable, but six major phenotypes are recognized: (1) encephalomyopathy, seizures, and ataxia; (2) infantile-onset multisystem disease; (3) cerebellar ataxia; (4) isolated myopathy; (5) Leigh syndrome; and (6) isolated nephrotic syndrome. Early treatment with exogenous CoQ10 supplementation may result in a good outcome.
Alkaptonuria
Authors: Introne Wendy J.
Published: September 2016

Alkaptonuria is an autosomal recessive disorder with an incidence of 1:250,000 to 1:500,000. Aside from urine that darkens, the disease is relatively asymptomatic in childhood. As a result, the diagnosis is often overlooked early in life and not considered in many patients until they begin to manifest symptoms as adults. Features include pigment deposition (ochronosis) on the eyes, ears, and hands; early-onset, progressive arthritis, particularly of the spine and large joints; valvular heart disease; and renal and prostate stones. Management continues to be symptomatic, but specific treatment with nitisinone appears promising with additional clinical trials being planned.
Citrin Deficiency
Authors: Buchaklian Adam H. , Dimmock David P.
Published: September 2016

Citrin deficiency is an inborn error of metabolism that appears to affect both the urea cycle and energy generation. Worldwide, citrin deficiency is likely one of the commonest inborn errors of metabolism, 60,000–80,000 individuals are estimated to have citrin deficiency in China alone. Children typically present with an abnormal newborn screen or neonatal intrahepatic cholestasis with citrin deficiency (NICCD). Adults typically present clinically with neuropsychiatric symptoms, hepatic dysfunction and hyperammonemia. As plasma amino acids typically show an elevated citrulline at the time of crisis, this presentation is known as citrullinemia type II (CTLN2). Without therapy, cases may progress to liver failure. Individuals may also suffer recurrent pancreatitis. In contrast to other urea cycle defects, the treatment for citrin deficiency requires a high protein, low carbohydrate diet. Acute hyperammonemia responds to arginine therapy. Sodium pyruvate has been reported to provide benefit. In addition many cases will require restriction of galactose. Liver transplant fully corrects the CTLN2 phenotype.
Cystathionine Beta-Synthase Deficiency or Classical Homocystinuria
Authors: Blom Henk J. , Janssen Mirian C.H. , Schiff Manuel
Published: September 2016

Inherited homocystinurias have in common accumulation of homocysteine and encompass two distinctive entities: classical homocystinuria due to cystathionine β‎-synthase (CBS) deficiency and the rare inborn errors of cobalamin and folate metabolism. The natural history of CBS deficiency, the subject of this chapter, is well described compared to the other forms of homocystinurias. Untreated patients may be asymptomatic or have one or more of the following symptoms: severe mental handicaps, psychiatric disturbances, ectopia lentis, osteoporosis, Marfanoid habitus, or thromboembolic complications. Current treatment options are based on therapy with vitamin B6, folate, B12, or betaine and institution of a protein- or methionine-restricted diet.
HHH Syndrome
Authors: Dionisi-Vici Carlo , Martinelli Diego , Bertini Enrico , Bachmann Claude
Published: September 2016

Hyperornithinemia-hyperammonemia-homocitrullinuria (HHH) syndrome is an autosomal recessive disorder of the urea cycle characterized by impaired transport of ornithine across the inner mitochondrial membrane. As seen in other urea cycle defects, in the acute phase the disease is characterized by intermittent episodes of hyperammonemia accompanied by vomiting, lethargy, and coma, with or without signs of acute liver failure. The disease course is characterized by a pyramidal tract dysfunction associated with myoclonic seizures and cerebellar symptoms. Most patients reaching adulthood manifest variable degrees of cognitive impairment and abnormal behavior. Long-term treatment consists of a low-protein diet supplemented with citrulline, arginine, or ornithine. Protein restriction may be combined with sodium benzoate. If plasma creatine levels are low, creatine supplementation should be instituted. Acute treatment is similar to other urea cycle defects.
Atypical Nonketotic Hyperglycinemia
Authors: Dinopoulos Argirios
Published: September 2016

Nonketotic hyperglycinemia (NKH) or glycine encephalopathy (GE) is an autosomal recessive inborn error of glycine degradation due to a defect in the glycine cleavage system (GCS). Accumulation of glycine, particularly in the central nervous system, leads to a variety of neurological symptoms, which may be progressive in infants. Clinical symptoms in atypical NKH are heterogeneous and, according to the age of presentation, cases can be divided in three forms: neonatal, infantile, and late onset. Late-onset atypical cases display an intermittent or a chronic course and may become apparent in adulthood. Psychiatric symptoms are common, and diagnosis may be difficult due to the rarity of the disorder. The CSF/plasma glycine ratio is diagnostic but in atypical cases is usually lower than the diagnostic cut-point for classical NKH. Treatment consists of dietary measures, but no consistent outcomes have been reported.
Abetalipoproteinemia and Hypobetalipoproteinemia
Authors: Hooper Amanda J. , Burnett John R.
Published: September 2016

Abetalipoproteinemia and hypobetalipoproteinemia are characterized by marked hypocholesterolemia and are classified depending on the lipid biochemical phenotype, gene involved, and mode of inheritance of the condition together with the severity of the mutation or mutations present. These disorders may or may not be associated with clinical manifestations such as fat malabsorption, growth failure, fat-soluble vitamin deficiency, fatty liver disease, and neuro-ophthalmological dysfunction. Early diagnosis and treatment with dietary modification and replacement of fat-soluble vitamins can prevent the clinical complications.
Spastic Paraplegia Type 5
Authors: Mochel Fanny
Published: September 2016

Spastic paraplegia type 5 (SPG5) is an autosomal recessive hereditary spastic paraplegia due to mutations in CYP7B1, which encodes oxysterol 7α‎-hydroxylase. Oxysterol 7α‎-hydroxylase is involved in the synthesis of bile acids from cholesterol. CYP7B1 mutations are responsible for rare forms of liver failure in infancy as well as lower motor neuron degeneration in adults with no obvious genotype-phenotype correlation. SPG5 is mostly characterized by spastic paraplegia with prominent posterior column sensory impairment that can lead to sensory ataxia and bladder dysfunction. SPG5 can easily be diagnosed thanks to the significant elevation of two plasma oxysterols: 27- and 25-hydroxycholesterol. Accordingly, plasma oxysterols are biomarkers that should be included in the screening of any spastic paraplegia of unknown etiology. Furthermore, the dramatic therapeutic response of a child with liver failure due to CYP7B1 mutations using chenodeoxycholic acid opens promising therapeutic perspectives for SPG5 patients, possibly as in cerebrotendinous xanthomatosis.
Disorders of Copper and Iron Metabolism
Authors: Trocello Jean-Marc , Woimant France
Published: September 2016

Both copper and iron are essential metals that have a critical function in a series of biochemical pathways. This chapter describes the disorders associated with genetic abnormalities in copper and iron metabolic pathways and their manifestations in adult patients. Mutations in the genes of the copper transporting P-type ATPases, ATP7A and ATP7B are associated with Wilson disease, Menkes disease, occipital horn syndrome and ATP7A-related distal motor neuropathy. Neurodegeneration with brain iron accumulation (NBIA) is a group of disorders characterized by excess iron deposition in globus pallidus, substantia nigra pars reticulata, striata and cerebellar dentate nuclei. Several genes associated with NBIA have been identified.
Pompe Disease
Authors: van der Ploeg Ans T. , Laforêt Pascal
Published: September 2016

Pompe disease, also named acid maltase deficiency and glycogen storage disease type II (GSDII), is a rare autosomal recessive disorder caused by the deficiency of the glycogen-degrading lysosomal enzyme acid α‎-glucosidase. The clinical spectrum of this disease is broad, varying from a lethal infantile-onset generalized myopathy including cardiomyopathy, to late-onset slowly progressive muscle weakness mimicking limb-girdle muscular dystrophy. Respiratory insufficiency is a frequent complication and the main cause of death. The prognosis of Pompe disease has changed considerably with the use of enzyme replacement therapy using recombinant acid α‎-glucosidase (alglucosidase alfa), which has been widely available since 2006. Improvements in survival and major motor achievements can be observed in patients with infantile forms, and recent studies demonstrate improvement of walking distance and stabilization of pulmonary function in late-onset forms. A longer-term study of the safety and efficacy of ERT, based on data gathering across the complete spectrum of Pompe disease via national or international patient registries, is needed in order to formulate more precise guidelines for treatment.
Neuronal Ceroid Lipofuscinoses
Authors: Caillaud Catherine , Sedel Frédéric
Published: September 2016

Neuronal ceroid lipofuscinoses (NCLs) are inherited neurodegenerative disorders beginning mainly in childhood, rarely in adults. They are characterized by the accumulation of autofluorescent lipopigments in brain, especially in neurons. Their clinical heterogeneity is now explained by the huge number of genes (from CLN1 to CLN14) involved in their pathogenesis. Their diagnosis is possible using enzymatic tests and/or direct sequencing of the corresponding genes. Different therapeutic approaches are in development for these diseases such as enzyme replacement therapy or gene transfer.
Peroxisomal Disorders
Authors: Poll-The Bwee Tien , Wanders Ronald J. A. , Waterham Hans R.
Published: September 2016

Peroxisomal disorders represent a group of disorders in which there is an impairment in one or more peroxisomal functions. Clinically, a dysfunction of peroxisomes results in most cases in neurologic symptoms of varying extent ranging from severe neurologic symptoms in children to late-onset disease in adults. In most peroxisomal disorders there is ocular and hearing involvement in combination with a multitude of other clinical manifestations. The peroxisomal disorders are subdivided into two major groups: (1) the peroxisome biogenesis disorders (PBDs), and (2) the single peroxisome enzyme deficiencies. The PBD group comprises the Zellweger spectrum disorders (ZSDs) and rhizomelic chondrodysplasia punctate type 1 (RCDP1) whereas the single peroxisomal enzyme deficiency group contains several different disorders including X-linked adrenoleukodystrophy as the most frequent disorder. Laboratory diagnosis of a peroxisomal disorder involves a variety of different biochemical assays in blood and urine, and should be followed up by detailed biochemical and celbiological studies in cultured fibroblasts including complementation analysis. Prenatal diagnosis is possible either by biochemical testing or by molecular analysis.
Disorders of Complex Lipids Synthesis and Remodeling
Authors: Lamari Foudil , Saudubray Jean-Marie
Published: September 2016

Defective lipid catabolic pathways are involved in numerous inherited metabolic diseases such as lysosomal storage diseases and peroxisome biogenesis disorders. We recently described a new classification of a rapidly growing group of inherited metabolic disorders involving biosynthesis and remodeling of complex lipids including phospholipids and sphingolipids. The remarkable progress achieved over the last decade in high throughput gene sequencing and in lipid analysis technologies have enabled the description of more than 40 diseases linked to defects in enzymes involved in these pathways. Some of these defects present in infancy or childhood but most of them are diagnosed in adolescence or adulthood. In this review we focus on those with adult presentation.
Hyperammonemia
Authors: Rabier Daniel
Published: September 2016

Ammonia, an end-product of protein and amino acid catabolism toxic to the brain, must be removed quickly from the circulation. Its removal is achieved in two steps: glutamine synthesis and urea synthesis. Hyperammonemia results from either an excess of production or defective elimination. There are two main etiologies of hyperammonemia: inherited or acquired. Inherited causes are mainly related to defective elimination while acquired ones result either from excess production or deficient detoxification. Good laboratory diagnostic tools are necessary to make the right diagnosis.
Hypoglycemia
Authors: Douillard Claire
Published: September 2016

Newly diagnosed hypoglycemia in an adult patient caused by a hitherto undiagnosed inborn error of metabolism is rare. However, the implications are important as follow-up and treatments may differ, especially when hypoglycemia is part of a multisystem disorder. This chapter describes the different inborn errors of metabolism that can present with or be revealed by hypoglycemia, with emphasis on the diagnostic work-up and symptoms.
Amino Acids
Authors: Rabier Daniel
Published: September 2016

Amino acids present in the different biological fluids belong to two groups: the protein group, with the 21 classical amino acids constituting the backbone of the protein, and the nonprotein group, appearing in different metabolic pathways as intermediate metabolites. It is important to know and to be able to recognize the latter, as they are the markers of many inherited metabolic diseases.
Three kinds of pathways must be considered: the catabolic pathways, the synthesis pathways, and the transport pathways. A disorder on a catabolic pathway induces an increase of all metabolites upstream and so an increase of the starting amino acid in all fluids. Any disorder on the synthetic pathway of a particular amino acid will induce a decrease of this amino acid in all fluids. When a transporter is located on a plasma membrane, its deficiency will result in normal or low concentration in plasma concomitant to a high excretion in urine.
Acceptance and the Recovery Paradigm in Mental Health Care
Authors: Mizock Lauren , Russinova Zlatka
Published: September 2016

Chapter 2 offers an overview of the recovery movement in the provision of mental health care for serious mental illness. Within the recovery movement in mental illness treatment, recovery is understood as a process of living a satisfying life of well-being and autonomy, as opposed to mere symptom elimination. Early theory of the recovery paradigm is outlined, highlighting the process of acceptance of serious mental illness within this model. Applications of the recovery paradigm to mental health care are discussed, as well as the various types of recovery from a serious mental illness. Acceptance is examined as the neglected paradox of recovery. Other parts of the chapter include discussion questions, activities, the “Personal Recovery Processes Worksheet,” and diagrams.
Czech Master Therapists
Authors: Řiháček Tomáš , Kahancová Mária , Jennings Len , Roubal Jan , Vybíral Zbyněk
Published: September 2016

Existing research suggests that although many master therapists’ characteristics are interculturally valid, at least some of these characteristics are culturally bound. Interviews with nine peer-nominated Czech expert psychotherapists were subjected to thematic analysis that revealed 16 themes, organized into six categories: (1) humble attitude toward mastery, clients, and colleagues; (2) relationship; (3) awareness of one’s needs, limits, and resources; (4) continuous development; (5) engagement; and (6) awareness of the complexity of psychotherapeutic work. The results are discussed in the context of cultural differences, as well as specific historical circumstances of the development of the Czech therapeutic scene. Despite the fact that master therapists’ characteristics show fundamental similarity across countries and cultures, conducting studies in diverse environments may contribute to the formulation of a rich and culturally sensitive description of what is means to be a master therapist.
Being and Becoming a Psychotherapist in Portugal
Authors: de Carvalho Helena Moura , Matos Paula Mena
Published: September 2016

The purpose of this work was to analyze the narratives of 20 Portuguese expert psychotherapists from different theoretical orientations on their personal and professional development during clinical practice. Using a constructive perspective of grounded theory analysis, two main themes emerged. The first theme focuses on the personal and professional experiences that contributed to the development of expert psychotherapists. This theme emphasizes the importance of dialogue and consistency between the personal and professional self-understanding of the development of the psychotherapist. In the second theme, the stages of development and changes of the psychotherapist are organized in two subthemes: (1) steps and changes in development of psychotherapists working in the professional domain and (2) steps and changes in development of psychotherapists in the personal domain. The findings highlight the need to consider the changes in personal and professional development in the study of the development of psychotherapists.
Session 7: Willingness (Part 2) and Values
Authors: Forman Evan M. , Butryn Meghan L.
Published: September 2016

This chapter (Session 7) presents additional information on willingness in the context of weight control and includes an exercise to help clients practice willingness by engaging in a behavior even when the client is simultaneously thinking that he or she cannot engage in that behavior. This chapter also introduces the concept of values, which are the most important ideas, principles, and domains in one’s life and which should drive behavior. Various valued domains are discussed, and clients are asked to begin to identify their personal values.
Session 16: Transitioning to Biweekly Meetings
Authors: Forman Evan M. , Butryn Meghan L.
Published: September 2016

This chapter presents Session 16, which focuses on the transition from weekly to biweekly meetings and reviews skills learned in the program thus far, including willingness, mindful decision-making, defusion, and values.
Session 4: Labels, Planning, and Calorie Accounting
Authors: Forman Evan M. , Butryn Meghan L.
Published: September 2016

This chapter describes Session 4. Topics include how to accurately read nutrition labels and the importance of meal planning when trying to meet a specific calorie goal. The idea of “calorie accounting” is introduced by comparing calories to a personal budget. The strategy of purposefully limiting calories one day to “bank” a greater number of calories to use for a larger meal later that week is presented, and clients are encouraged to tally calories throughout the day to make informed decisions about how many calories to spend at each meal.
Session 24: Looking Ahead
Authors: Forman Evan M. , Butryn Meghan L.
Published: September 2016

This chapter presents Session 24, which focuses on the upcoming end of treatment and clients’ anticipated challenges after treatment ends, as well as long-term goals to continue with weight control behaviors. Key behavioral (e.g., self-monitoring, limiting calorie intake) and psychological (e.g., defusion, willingness) strategies are presented to promote long-term weight control.
Is Exposure Therapy Necessary to Treat PTSD?
Authors: Markowitz John C.
Published: September 2016

This chapter discusses the dominance of the exposure-based approach to therapy of PTSD, and of IPT as an alternative affect- and attachment-based, non-exposure approach. The chapter, based in part on published research articles, reviews prior research and recent findings from our randomized controlled treatment trial comparing exposure-focused Prolonged Exposure, IPT, and Relaxation Therapy for patients with chronic PTSD. Results showed that IPT was non-inferior to Prolonged Exposure and had advantages for patients with comorbid major depressive disorder—half the sample. Patients also preferred IPT to the other treatments, despite its having far less research support. Patients treated for 14 weeks with psychotherapy targeting PTSD were likely to lose the diagnosis of a personality disorder.
IPT for PTSD—Role Disputes
Authors: Markowitz John C.
Published: September 2016

Comparable to Chapters 7 and 8, this chapter focuses on the IPT focal area of role disputes. It includes two extended case examples. Components of these cases include the initial, middle, and termination phases, and the use of techniques including history taking, formulation, affective attunement, role play, and the issue of transgressions.
Practical Issues
Authors: Markowitz John C.
Published: September 2016

This short summary, based on our original research manual, provides lists of therapist “Do’s and Don’ts.” Do’s include scheduling sessions, audiotaping or videotaping, giving the patient an IPT background handout, writing a progress note, and serially rating patients. Don’ts include encouraging patient exposure to trauma reminders and assigning homework. The best guide for this is supervision.
Textbook of Evolutionary Psychiatry and Psychosomatic Medicine
Authors: Brüne Martin
Published: September 2016

Psychiatry and psychosomatic medicine are concerned with medical conditions affecting the brain, mind, and behaviour in manifold ways. Traditional approaches have focused on a restricted array of potential causes of psychiatric and psychosomatic conditions, including adverse experiences such as trauma, neglect, or abuse, genetic vulnerability, and epigenetic regulation of gene expression. While essential for the understanding of mental disorders, these approaches have disregarded pertinent questions such as why the human mind is vulnerable to dysfunction at all. This Textbook of Evolutionary Psychiatry and Psychosomatic Medicine seeks to find answers to these questions by emphasizing an evolutionary perspective on psychiatric and psychosomatic conditions. It explains how the human brain/mind has been shaped by natural and sexual selection; why adaptations to environmental conditions in our evolutionary past may nowadays work in suboptimal ways; and how human cognition, emotions, and behaviour can be scientifically framed to improve our understanding of how people try to attain important biosocial goals pertaining to one’s status in society, mating, eliciting and providing care, and maintaining rewarding relationships. The evolutionary topics relevant to the understanding of psychiatric and psychosomatic conditions include the concepts of genetic plasticity, life-history theory, stress regulation, and immunological aspects. In addition, it is argued that an evolutionary framework is necessary to understand how psychotherapy and psychopharmacology work to improve the lives of patients with psychiatric and psychosomatic disorders.
Causes of psychopathology
Authors: Brüne Martin
Published: September 2016

The causes of psychiatric and psychosomatic conditions can be categorized into two groups: proximate and ultimate (evolutionary) causes. Proximate causes comprise genetic factors, epigenetic modulation, childhood trauma and other life events, and senescence. Ultimate or evolutionary causes concern mismatch between adaptation and current environment, suboptimal design, and design compromises. Examples of evolutionary causes of dysfunction include cognitive and emotional adaptations to small-scale societies (mismatch), anxiety (suboptimal design), premature birth (design compromise), and other features associated with human life history. Furthermore, many ‘diseases of civilization’ fall under the category of mismatch, as well as immunological diseases that may arise from a lack of exposure to pathogens early in life. Prevention of psychopathology, though desirable, may not always be possible due to the fact that evolution does not select for emotional well-being. However, reducing the impact of early adversity and helping people develop alternative life-history strategies may be an attainable goal.
Neurocognitive disorders
Authors: Brüne Martin
Published: September 2016

Neurocognitive disorders affect a broad array of cognitive domains, but produce also emotional and behavioural signs. Dementia is most prevalent among the neurocognitive disorders, with Alzheimer’s disease being the most common form. Neurocognitive dysfunction is related to aging and senescence. Evolutionary considerations suggest that senescence has escaped selection, because most individual of a population would die before the onset of senescence. However, there is some evidence that longevity has been positively selected during human evolution. It is possible that the human isoforms of the ApoE gene, ApoE2 and E3, were positively selected during periods of rapid increase in brain size some 1.5 million years ago, and that they may have evolved as an adaptation to the increasing intake of a protein-rich diet (i.e. meat). A-beta and neurofibrillary tangles may, on the other hand, have antimicrobial properties, which could tell a different story with regard to the evolutionary history of dementia.
Values
Authors: Schwartz Shalom H. , Cieciuch Jan
Published: September 2016

The concept and measurement of values undergoes continued development and change. Yet several issues persist. Are people aware of their values, or are values unavailable to conscious awareness? Shouldvalues be measured directly because people can articulate them, or indirectly because people have no access to them? Can these views be reconciled? While tracing the development of values theory through the approaches of Allport and Vernon, Rokeach, and Schwartz, this chapter examines these and other questions that values researchers confront. Is there a comprehensive set of human values and how could one discover it? To what extent are people’s values organized into meaningful systems and on what bases? What different methods are there to measure values in adults and children? What assumptions do these methods make about the nature of values? What are the advantages and disadvantages of rating versus ranking techniques? What new directions is value measurement taking?
Psychopathology
Authors: Pedrero Eduardo Fonseca , Gooding Diane C. , Debbané Martin , Muñiz José
Published: September 2016

This chapter reviews the assessment of psychopathology, with a focus on psychosis and clinically related phenomena and conditions, such as prodromal phases and at-risk mental states of psychosis. The psychosis syndrome, which is characterized by a disruption of higher cognitive functions, can be found when any basic psychological process (e.g., memory, attention, etc.) is altered. It is used here as an example of psychopathological disorder. The chapter begins with an overview of the psychosis syndrome as a model of psychopathological disorder, emphasizing its core domains (i.e., positive, negative, and cognitive symptoms). It discusses the main psychological tests and procedures for psychosis assessment and provides an overall review of measurement instruments for psychosis risk assessment from both clinical and psychometric high-risk paradigms, where psychological testing plays a crucial role in terms of detecting people at risk for psychosis prior to developing serious mental disorder and need for care.
Session 5: Continued Problem-Solving/Modeling Healthy Responses to Anxiety
Authors: Peris Tara S. , Piacentini John
Published: September 2016

This chapter provides a guide to continued family problem solving. It begins with a review of skills learned earlier in treatment as well as progress with the initial family issues they have begun to address. It provides a strategy for picking the next family problem to target, with an emphasis on giving the family more independence during problem solving exercises. The chapter discusses the parents’ inadvertent potential to reinforce OCD behavior in their behaviors and in their speech. Parents who are particularly anxious may have difficulty managing their emotions in the moment, even though they understand the concept of modeling. The chapter provides strategies for helping these parents navigate OCD-related situations that may trigger their anxiety. Focus of the chapter continues to skills training in emotion regulation, including in-session practice exercises and discussion of the importance of modelling healthy responses to anxiety.
The Shifting Political Winds
Authors: Lugg Catherine A. , Murphy Jason P.
Published: September 2016

This chapter teases out how shifting currents in US educational policy and politics vis-à-vis LGBTQ students conflict by employing a lens from the politics of education literature: street-level bureaucrats. Regardless of the intent of a policy’s authors, how street-level bureaucrats (career civil servants like public educators) define a policy through their implementation becomes the actual meaning of the policy. Given the shifting political winds regarding LGBTQ identity and educational policy, teasing out whose understandings of a given policy are actually implemented is critical for the well-being of LGBT students attending US public schools. Educators, as street-level bureaucrats, have the potential to find spaces within these broader political and policy changes to better serve as supports for LGBT students. Finally, in the United States and other locales, economic decline can amplify political discontent, including conflicts over the course and scope of educational policies.
Getting Started
Authors: Lecomte Tania , Leclerc Claude , Wykes Til
Published: September 2016

This chapter covers all that needs to be put in place prior to starting a CBT for psychosis group and how to ensure attendance. We discuss what needs to be considered in terms of recruitment according to the setting, selection of participants (e.g. homogeneous group or not), the choice of the setting, schedule and frequency of sessions (e.g. once or twice a week), the advantages of using of a participant manual or workbook, and material that need to be planned ahead (e.g. flip-charts, snacks). The chapter also covers transportation issues, problems with attendance, vacation breaks or missed sessions, and proposes to consider measuring outcomes expected in terms of participant change at the end of the group.
Measuring Change
Authors: Lecomte Tania , Leclerc Claude , Wykes Til
Published: September 2016

The success of cognitive behavior therapy in general, as well as CBTp, stems in great part from demonstrating changes in symptoms over time, with measures showing improvements between pretherapy and both post-therapy and follow-up. This chapter proposes measures that can be used quickly and efficiently in a clinical setting to demonstrate the impact of the group CBTp. Measures specific to CBT for psychosis such as the CHOICE, as well as measures of concepts that have shown improvements following CBTp, such as symptoms, self-esteem, coping skills, social support, self-stigma, and social functioning, are described. Other measures of interest to assessing processes in therapy, such as alliance with therapists, group cohesion, participation within the group, and measures of treatment fidelity or therapist competence are also suggested.
Gram-Positive Diplococci in a Cerebrospinal Fluid Gram Stain
Authors: Collins Jennifer P. , Westblade Lars F. , Anderson Evan J.
Published: September 2016

A 5-month-old girl presented with meningitis after receiving amoxicillin for bilateral otitis media. The cerebrospinal fluid (CSF) Gram stain suggested Streptococcus pneumoniae: Gram-positive diplococci with a surrounding clear area indicative of a bacterial capsule. Her CSF and blood cultures grew penicillin-resistant S pneumoniae serotype 35B. This serotype is not included in the 13-valent pneumococcal conjugate vaccine (PCV-13) and has been identified as a cause of invasive pneumococcal disease in the post-PCV-13 era.
Gravitational waves from an SMBH binary in M 87
Authors: Yonemaru Naoyuki , Kumamoto Hiroki , Kuroyanagi Sachiko , Takahashi Keitaro , Silk Joseph
Published: September 2016

We study gravitational-wave (GW) emission from a hypothetical supermassive black-hole (SMBH) binary at the center of M 87. The existence of an SMBH other than that usually identified with the central active galactic nucleus (AGN) is a possible explanation for the observed displacement [∼O(1) pc] between the AGN and the galactic centroid, and it is reasonable to assume considering the evolution of SMBHs through galaxy mergers. Because the period of the binary and the resulting GWs is much longer than the observational time-span, we calculate the variation of the GW amplitude, rather than the amplitude itself. We investigate its dependence on the orbital elements and the second BH mass, taking the observational constraints into account. The frequency of the GWs is too low to be detected with the conventional pulsar timing array and we propose a new method for detecting such low-frequency GWs with the distribution function of pulsar spin-down rates. Although the GWs from an SMBH binary that explains the observed displacement are extremely hard to detect even by the new method, GWs are still useful for probing the M 87 center.
Dry Flower Disease ofMacadamiain Australia Caused byNeopestalotiopsis macadamiaesp. nov. andPestalotiopsis macadamiaesp. nov.
Authors: Akinsanmi Olufemi A. , Nisa Shaheen , Jeff-Ego Olumide S. , Shivas Roger G. , Drenth André
Published: September 2016

Incidence of dry flower disease of macadamia (Macadamia integrifolia), expressed as blight of the flowers and necrosis and dieback of the rachis, is increasing in Australia. In the 2012–13 production season, incidence of dry flower disease resulted in 10 to 30% yield loss in the affected orchards. Etiology of the disease has not been established. This study was established to characterize the disease and identify the causal pathogen. A survey of the major macadamia-producing regions in Australia revealed dry flower disease symptoms regardless of cultivar or location at all stages of raceme development. Based on colony and conidial morphology, the majority (41%) of fungal isolates obtained from tissue samples were identified as Pestalotiopsis and Neopestalotiopsis spp. The phylogeny of the combined partial sequence of the internal transcribed spacer, β-tubulin, and translation elongation factor 1-α gene loci segregated the isolates into two well-supported clades, independent of location or part of the inflorescence affected. Further morphological examination supported the establishment of two new species, which are formally described as Neopestalotiopsis macadamiae sp. nov. and Pestalotiopsis macadamiae sp. nov. Using spore suspensions of isolates of both species, Koch’s postulates were fulfilled on three macadamia cultivars at all stages of raceme development. To our knowledge, this is the first report of species of Neopestalotiopsis and Pestalotiopsis as causal agents of inflorescence disease in macadamia.
The mindful nurse leader
Authors: FitzPatrick Kate , Doucette Jeffrey N. , Cotton Amy , Arnow Debra , Pipe Teri
Published: September 2016

In this second installment of a three-part series on mindfulness, we describe the process of producing video vignettes to illustrate how clinical nurses draw on the power of mindfulness to build their own resiliency while delivering compassionate care.
Multifidus Muscle Atrophy Not Observed Following Two-segment Anterior Interbody Fusion
Authors: Xu Wen-Bin , Liu Jun-Hui , Chen Zhi-Jun , Fang Xiang-Qian , Fan Shun-Wu , Hu Zhi-Jun
Published: September 2016

Study Design.

Experimental study evaluated magnetic resonance imaging (MRI) and histologic changes in the multifidus muscle after anterior spinal fusion.

Objective.

To determine the effect of spinal fusion on the multifidus muscle in an anterior rabbit model through the use of MRI and histologic evaluation.

Summary of Background Data.

Retraction and splitting approach are known to be important factors in postoperative injury and atrophy of the multifidus muscle. The effect and possible mechanism of spinal fusion as an independent factor remains unknown.

Methods.

Thirty-six New Zealand white rabbits were divided into two groups. Animals in the fusion group underwent two-level anterior spinal fusion whereas those in the control group underwent similar surgery without spinal fusion. The status of the multifidus muscle was evaluated with MRI and histological analysis at preoperative, 3 weeks, 6 weeks, 3 months, 6 months, and 12 months postoperatively.

Results.

All rabbits in the fusion group achieved solid fusion. The mean T1-weighted and T2-weighted signal intensity ratios of gross multifidus to psoas muscles were all approximately 1.0 postoperatively, with no remarkable difference between the groups. The mean lesser diameter of myofibrils in either group did not significantly differ between the preoperative and postoperative specimens. There was no significant fibrotic change or fatty degeneration for either group. Decrease in acetylcholine activity or granular degeneration of the neuromuscular junction were not observed, and normal shape and size were found in nearly all samples at all time points in both groups (P > 0.05).

Conclusion.

After two-segment anterior spinal fusion, multifidus atrophy was not observed throughout a 12-month follow up. The rabbit model of anterior fusion is better suited to study the effect of fusion alone on the status of the multifidus muscle.

Level of Evidence: 3
Single-stage Reconstruction of Elbow Flexion Associated with Massive Soft-Tissue Defect Using the Latissimus Dorsi Muscle Bipolar Rotational Transfer
Authors: Stevanovic Milan V. , Cuéllar Vanessa G. , Ghiassi Alidad , Sharpe Frances
Published: September 2016

Introduction:

In the upper extremity, the latissimus dorsi muscle can be used as an ipsilateral rotational muscle flap for soft-tissue coverage or functional reconstruction of arm and elbow. Patients who have both major soft-tissue loss and functional deficits can be successfully treated with a single-stage functional latissimus dorsi rotational muscle transfer that provides simultaneous soft-tissue coverage and functional reconstruction.

Methods:

Our data base was queried for all patients undergoing a rotational latissimus dorsi muscle transfer for simultaneous soft-tissue coverage and functional reconstruction of elbow flexion. Four patients were identified. A chart review documented the mechanism of injury, associated injuries, soft-tissue defect size, number of surgical procedures, length of follow-up, last elbow range of motion, and flexion strength.

Results:

Four patients with loss of elbow flexion due to traumatic loss of the anterior compartment muscles and the overlying soft tissue underwent simultaneous soft-tissue coverage and elbow flexorplasty using the ipsilateral latissimus dorsi as a bipolar muscle rotational tissue transfer. All flaps survived and had a recovery of Medical Research Council Grade 4/5 elbow flexion strength. No additional procedures were required for elbow flexion. The surgical technique is described and supplemented with surgical technique video and patient outcome.

Conclusions:

This patient series augments the data provided in other series supporting the safety and efficacy of this procedure which provides both soft-tissue coverage and functional restoration of elbow flexion as a single-stage procedure in the setting of massive traumatic soft-tissue loss of the arm.