bluuebunny/crossref_metadata_2025 huggingface dataset:
Depressive Disorders
Authors: Chopra Amit , Bachu Ramya , Peterson Michael J.
Published: February 2021

Depressive disorders are commonly associated with sleep disturbances including insomnia, hypersomnia, and nightmares. Based on shared neurobiological mechanisms, a bidirectional link exists between sleep disturbances and depressive disorders. Presence of sleep disturbance is not only associated with increased depression severity but also portends a poorer prognosis with increased suicide risk in patients with depressive disorders. Polysomnographic findings such as reduced slow-wave sleep, decreased rapid eye movement (REM) sleep latency and increased REM density are associated with major depression. Comorbid primary sleep disorders such as obstructive sleep apnea, restless legs syndrome, and circadian rhythm disorders not only increase the risk but also complicate the treatment of major depression. It is imperative to comprehensively assess and treat sleep disturbances, either due to depression or due to co-existing primary sleep disorders, to optimize remission, prevent relapse, and reduce the risk of suicide in patients with depressive disorders. Medications, chronotherapies, and behavioral approaches alone or in combination may prove to be effective in treating sleep disturbances associated with depressive disorders; however, more research is warranted in this area to determine the optimal management strategies. Cognitive behavioral therapy for insomnia, a promising treatment for management of insomnia comorbid with major depression, needs wider implementation and more research to establish its efficacy in preventing suicide.
Schizophrenia Spectrum and Other Psychotic Disorders
Authors: Au Chi-Hung , Chan Man-Sum , Chung Ka-Fai
Published: February 2021

While symptoms such as hallucinations and delusions attract the most attention from psychiatrists; sleep disturbances, although common in schizophrenia, are often overlooked or undertreated. It is estimated that 30% up to 80% of patients with schizophrenia suffer from insomnia, 15% from obstructive sleep apnea, 21% from restless leg syndrome, and 17% from a sleep-related eating disorder. Sleep disturbances have negative impact on patients’ physical health and quality of life and may aggravate neuropsychiatric symptoms in schizophrenia. This chapter serves as a concise guide for psychiatrists and other healthcare professionals to understand the assessment and management of sleep disturbances in schizophrenia spectrum and other psychotic disorders. Future research is needed to elucidate the genetic and longitudinal relationship between comorbid sleep disorders and schizophrenia, to evaluate the impact of comorbid sleep disorders and their treatment on clinical and functional outcomes, and to identify novel sleep therapies for patients with schizophrenia.
Neurological Disorders
Authors: Patel Rikinkumar S. , Loganathan Muruga , Louis Erik K. St. , Chopra Amit
Published: February 2021

Sleep disorders are frequent in patients with neurological disorders and worsen neurological, psychiatric, cognitive and rehabilitation outcomes. Optimal management of sleep disorders in neurological diseases has been associated with significantly improved clinical and quality of life outcomes. Yet, sleep disorders are often underrecognized and undertreated in neurological patients. This chapter highlights the prevalence, risk factors, pathophysiology, clinical implications, and management of common sleep disorders in neurological disorder including Parkinson’s disease, epilepsy, stroke, multiple sclerosis, and traumatic brain injury. More research is warranted to fully understand this comorbidity and to consolidate evidence-based guidelines for management of sleep disorders in neurological patients.
Future of Sleep Medicine and Psychiatry
Authors: Shaha David P. , Capaldi Vincent F. , Williams Scott G. , Fang Beverly , Wickwire Emerson M.
Published: February 2021

As evidenced throughout this volume, sleep and psychiatry are deeply intertwined. Sleep and psychiatric processes share multiple biologic underpinnings, and sleep and psychiatric disorders are highly comorbid, with an additive adverse impact. Yet, much remains unknown, and much work remains to optimize treatments of sleep disorders in psychiatric populations. This chapter is to consider these issues with an eye toward the future. The chapter briefly considers sleep medicine education in psychiatry, drug development and novel compounds, consumer wearables, behavioral and complementary approaches, telehealth, and sleep health economics. The authors argue for the need to a value-based approach to sleep and psychiatry.
Long-Acting Reversible Contraception Versus Pills/Patch/Ring
Authors: Danvers Antoinette , Schmidt Elizabeth B.
Published: February 2021

The CHOICE study was a prospective cohort study of 7486 women in St. Louis, Missouri. The participants underwent standard, scripted contraceptive counseling and were provided with their choice of contraception at no cost. Primary outcomes were contraceptive failure and pregnancy rates in 2 age groups: women over 21 and less than 21 years old. Participants who chose long-acting reversible contraception (LARC) such as an intrauterine device or the contraceptive implant were less likely to experience a contraceptive failure compared to contraceptive pill, patch, ring (PPR) users (p = 0.001). Participants using PPR were 22 times more likely to have an unintended pregnancy than those using LARC. Among women less than 21 years old who used non-LARC methods, the risk of pregnancy was nearly twice as high than older women. LARC are highly-effective and safe for women of all ages and should be considered first-line methods of contraception for most patients.
Pelvic Organ Function After Total Versus Subtotal Abdominal Hysterectomy
Authors: Tsai Susan , Traylor Jessica , Milad Magdy
Published: February 2021

This study is a randomized, double-blind trial comparing total and subtotal abdominal hysterectomy in 279 women who underwent hysterectomy for benign disease. The authors aimed to evaluate measures of bladder, bowel, and sexual function at 12 months as well as postoperative complications. This study demonstrated no difference in pelvic floor function at 12 months. Subtotal hysterectomy did have fewer complications and more rapid recovery but did have a higher incidence of subsequent prolapse or cyclical bleeding.
Update on the War on Mental Illness
Authors: Perry Seth W , Wong Ma-Li , Licinio Julio
Published: February 2021

The authors first called for a “war on mental illness” in 2013. In this update, they re-establish and expand the previous concepts and arguments for translational psychiatry’s role in combating mental health disorders worldwide. The authors discuss the six steps of translational science (discovery, first in humans or proof of principle, clinical trials, healthcare policy and guidelines, long-term effectiveness and safety, and global health). Further, they highlight progress made since their initial call to action and renew and update their call with increased attention to how the principles of transdisciplinary and convergence science can be harnessed for expediting and maximizing progress toward new and improved therapies for mental illness.
Conclusion
Authors: Roth Andrew J. , Nelson Christian J.
Published: February 2021

The art of diagnosing depression, anxiety, delirium, insomnia and fatigue in cancer care is not always straightforward. We have laid out pearls and potholes to assist uncovering the varied and sometimes hidden sources of that distress; to be aware of which syndromes may be amenable to a psychopharmacologic intervention; to know when to refer to prescribers or specialists in Psycho-Oncology; to hone communication techniques that will facilitate a patient’s care; to learn about the strategies Psycho-Oncologists use to choose the right medications for particular situations; and to recognize how to watch for the benefits and side effects of those medications, which if not understood by all providers and patients, can lead to premature discontinuation of potential helpful remedies or untoward side effects.
What Are Empathy and Compassion? A Western Perspective
Authors: Wong Agnes M.F.
Published: February 2021

In this chapter, the author examines the definitions of empathy and compassion, including self-compassion, and explains why “compassion fatigue” is a misnomer. Although empathy and compassion are distinct, they have been used interchangeably, which has helped perpetuate the common misconception that compassion is finite and emotionally draining. The author illustrates that “empathy fatigue” is a better term to describe the empathic distress and burnout that are widespread in healthcare. The chapter also looks at how empathy and its precursors (found in primitive mammalian species) evolved over time into compassion, which requires higher order executive functions that are found in primates only. The chapter explores how humans became successful as a species because of our nurturing, altruistic, and compassionate attributes that have evolved over millions of years.
Life course, exposure, and ageing populations
Authors: Ben-Shlomo Yoav
Published: February 2021

The demographic changes experienced globally mean that the 21st century faces the challenge of caring for an ageing population. Without preventative measures, this will be further aggravated by the successes of medical technologies which continue to reduce case fatality and hence add to the multi-morbid nature of older populations. A life-course approach to ageing conceptualizes the different trajectories by which traits may decline before leading to clinical disease or disability. It highlights gaps in our current understanding of the drivers of such trajectories and periods where the timing of adverse exposures may have a disproportionate negative or positive impact on later life outcomes. This is illustrated with a wide variety of examples and applied to neurodegenerative disorders such as dementia. Future primary and secondary preventative measures must consider interventions across the whole of the life course.
Cardiometabolic morbidities and dementia
Authors: Qiu Chengxuan , Liborio Vetrano Davide , Fratiglioni Laura
Published: February 2021

Cardiometabolic morbidities and dementia are increasingly common as people age. In this chapter, we summarize the epidemiological literature concerning: (1) mixed dementia due to cerebrovascular and neurodegenerative lesions as the most common form of dementia in older people; (2) the relation of cardiovascular disease with cognitive decline and dementia and the underlying pathophysiological mechanisms; and (3) cardiovascular comorbidities in dementia and impact on dementia care and prognosis. Atherosclerotic and arteriosclerotic disorders resulting from long-term exposures to cardiovascular risk factors, together with neurodegeneration in brain ageing, contribute to accelerated cognitive decline and dementia. The heart-brain connection in ageing has implications for dementia interventions. Furthermore, cardiovascular comorbidities in dementia contribute to poor outcomes, create complex challenges for dementia care, and substantially increase social care costs of dementia. Thus, early recognition and management of cardiovascular comorbidities in dementia may help health and social care providers maximize the well-being of people with dementia.
Dementia and Parkinson’s disease
Authors: Savica Rodolfo , Turcano Pierpaolo
Published: February 2021

Parkinson’s disease (PD) is a neurodegenerative disease that shares a number of clinical, pathological, and epidemiological characteristics with dementing illnesses. In addition, PD and related disorders have been associated with cognitive decline/dementia. The timeline of the symptom onset as well as the clinical phenotypes are crucial to define the diseases such as dementia with Lewy bodies and Parkinson’s disease dementia. The epidemiological figures of prevalence and incidence are somewhat limited, but are influenced by diagnostic criteria, geographic locations, and methodological limitations. However, it seems that age has a major role in the increase of prevalence and incidence of PD and dementia; additionally men seem to be consistently more affected than women.
Amyotrophic lateral sclerosis (ALS) and fronto-temporal dementia (FTD)
Authors: Logroscino Giancarlo , Chiò Adriano
Published: February 2021

Amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD) are both progressive neurodegenerative disorders considered part of the same spectrum of overlapping genetic neurological and clinical diseases. ALS involves primarily the motor system, but recent advances consider also the involvement of other parts of the central nervous system (CNS), primarily cognition. FTD presents clinical syndromes with behavioural and language variants, but some subtypes have motor involvement of the motor pathways and/or of some extrapyramidal areas. C9ORF72 is a gene responsible for 7–10% of cases both of sporadic and familial of ALS and FTD as well. Both ALS and FTD are rare diseases with incidence around 3/100,000 for ALS in Europe and FTD probably lower. The data for ALS have been mainly produced in Europe by a system of registries in limited territories. FTD data from populations are sparse. Trauma, smoking, military service, and agricultural occupation are environmental probable risk factors for ALS. No analytic data are available for FTD. FUS, TARDP, SOD 1, and C9ORF72 are the main genes involved in ALS, while C9ORF72, PGR, and TAU have been reported in FTD.
The oldest-old and dementia at the end of life
Authors: Corrada María M , Kawas Claudia H
Published: February 2021

The oldest-old and dementia at the end of life describes what is known about the prevalence, incidence, and risk factors for dementia in people aged 90 and older, the fastest growing segment of the population in much of the world. It reviews the main neuropathological abnormalities found during autopsy, including Alzheimer’s disease (AD), vascular lesions, and hippocampal sclerosis and discusses how these abnormalities are related to dementia in very elderly individuals. The chapter highlights differences in risk and protective factors, and underlying neuropathologies associated with dementia compared to younger elderly. Taking into consideration the rapid increase in the number of oldest-old by the middle of the century, it reviews the potential impact of interventions to reduce Alzheimer’s disease pathology on the prevalence of dementia in this age group. Finally, it presents methodological challenges in studying this age group and offers potential strategies to address some of these challenges.
Global stroke burden and prevention strategies
Authors: Krishnamurthi Rita , Feigin Valery L
Published: February 2021

The absolute numbers of stroke and the worldwide prevalence of stroke are set to increase, due to population ageing, population growth, and increased exposure to risk factors, especially in developing countries. The continued surveillance of stroke burden, in terms of incidence, disability-adjusted life years (DALYs) and mortality, as well as trends in the prevalence and attributable stroke burden of associated risk factors is crucial for informing management and prevention strategies. The Global Burden of Studies provides the most accurate estimates of current stroke burden as well as trends in stroke burden since 1990, in terms of prevalence, incidence, mortality, and DALYs. This chapter presents the findings of GBD 2015 for stroke burden, as well as trends in global and regional stroke burden and risk factors since 1990.
Methods and approaches to examining the interface of late-life depression and dementia
Authors: Geerlings Mirjam I
Published: February 2021

Late-life depression increases the risk of dementia. The exact nature of this relationship is not clear, however. Late-life depression may be a causal factor in the development of dementia, but is may also be a preclinical or prodromal symptom of dementia. This chapter reviews the approaches used to examine the interface between depression and dementia, and reviews existing evidence for the two main hypotheses to explain this relationship: the neurotoxicity hypothesis stating that dysregulation of the hypothalamic-pituitary-adrenal axis resulting from repeated depressive episodes has neurotoxic effects on the hippocampus, and the vascular hypothesis stating that depression precedes dementia through small vessel ischaemic changes in mood-regulating brain areas. It then discusses a number of methodological issues and limitations of existing studies relating to study design, and definition and measurement of late-life depression, and proposes future directions for research.
Multiple sclerosis
Authors: Celius Elisabeth Gulowsen
Published: February 2021

This chapter describes the incidence and prevalence of multiple sclerosis (MS) and shows the uneven distribution across the world. Despite differences in diagnostic criteria over time and considerable variation in methodology the prevalence is higher in northern Europe, the northern part of North America, Australia, and New Zealand compared to the rest of the world. There is an unexplained increase in both incidence and prevalence across the world. The increased life expectancy correlates with the general increase in life expectancy and is so far neither explained by better diagnostics nor new treatments. Epidemiological studies are essential for our understanding of disease susceptibility and progression, and essential for planning of healthcare. Future studies should be large, methodologically sound, and comparable to enable comparisons across countries and regions.
Metals and neurodegeneration
Authors: Peters Susan , Visser Anne E , Weisskopf Marc , Kioumourtzoglou Marianthi-Anna , Vermeulen Roel
Published: February 2021

Neurodegenerative disorders, including Alzheimer’s disease, amyotrophic lateral sclerosis, and Parkinson’s disease, are thought to be caused by both genetic and environmental factors. Several metals and metalloids have been identified as neurotoxicants and exposure may occur, for example, via air pollution, contaminated food or drinking water, cigarette smoke, or in occupational settings. Epidemiological evidence of associations between metal exposure and neurodegenerative disorders, however, is scarce. Here we provide an overview of metals that have been suggested to play a role in neurodegeneration. Investigating these associations is challenged by accurate case ascertainment due to complicated diagnosis, multifactorial disease mechanisms, long latency requiring retrospective exposure assessment, and possible reverse causality when comparing cases and controls. Further research on understanding the role of metals in the pathology of neurodegenerative disorders is needed. Future epidemiological studies should be large and high-quality studies to provide the crucial evidence on metal exposures as possible risk factors.
Estimating the global burden of stroke
Authors: Truelsen Thomas , Johnson Catherine , Naghavi Mohsen , Vos Theo , Feigin Valery L , Roth Gregory
Published: February 2021

The Global Burden of Disease (GBD) study has provided global estimates on stroke since the 1990s. Estimates from the GBD are used to help appropriately plan and prioritize stroke care, prevention, and research activities in many countries. GBD 2015 represents the best and most consistent data for understanding the global burden of stroke, which remains a leading cause of death and disability. In this chapter we discuss current methods used to produce global and national estimates of health loss due to stroke, as well as challenges and future directions for population-level health metrics related to stroke.
What is the role of trials and other ‘well-designed’ studies in the understanding of neurological and neuropsychiatric conditions
Authors: Brayne Carol
Published: February 2021

This chapter lays out a brief summary of the ways in which we bring our contemporary and past knowledge of disorders together in a way that can integrate impact for society. The value of diagnosis can be viewed from different perspectives and sectors of any particular society. There have been many changes to the definitions of many, if not most, disorders and diseases affecting human populations due to changing biologies and new methods of investigation. This includes change in diagnostic approaches and definitions, the approaches currently used in Global Burden of Disease and Health Life Expectancies as well as public health approaches to bringing together evidence about primary, secondary, and tertiary prevention.
The role of prevention in common neurological disorders
Authors: Logroscino Giancarlo , Brayne Carol , Tortelli Rosanna
Published: February 2021

Prevention is a fundamental part of medicine for populations and may be key to reduce the number of people at risk and with disease. The area of neurodegenerative diseases (NDD) epidemiology is changing very rapidly because: (1) High prevalence of NDD due to the ageing of the general population. (2) Awareness that pathological changes leading to clinical expression are present decades before clinical onset. (3) Biomarkers may identify biological type and severity of neurodegeneration after and before the clinical onset of disease. In this scenario, which is leading to new definitions of disease and disease onset, primary, secondary and tertiary prevention may be also newly defined. A population strategy in which NDD onset is shifted to later ages has probably the greatest public health impact. Epidemiology, a pragmatic science with an integrated and multifocal approach, is strongly needed in the area of NDD prevention.
Evidence base for off-pump coronary artery bypass grafting
Authors: Moss Emmanuel , Halkos Michael E. , Puskas John D.
Published: February 2021

The relative merits of off-pump versus on-pump coronary artery bypass grafting have been compared for almost three decades. Off-pump coronary artery bypass grafting was pioneered in the 1990s on the premise that avoiding the use of the heart–lung machine could minimize the morbidity associated with coronary artery bypass grafting surgery, particularly in high-risk patient subgroups. More recently, the correlation between extent of aortic manipulation and incidence of perioperative stroke has been cited as another potential benefit of off-pump coronary artery bypass grafting surgery when it is performed with a no-aortic-touch technique. The trade-off for avoiding the heart–lung machine is a more technically demanding operation that, according to some reports, may lead to a less complete revascularization and decreased long-term graft patency.
Management of cardiopulmonary bypass
Authors: Baker Robert A. , Fitzgerald David , Groom Robert C.
Published: February 2021

Cardiopulmonary bypass provides the surgical team with the most controlled environment to perform the precise anastomoses needed for a successful coronary artery bypass graft operation. It not only promotes the most stable surgical field, but it utilizes a range of techniques that benefit both the surgeon and the patient. This chapter aims to provide the surgical team with an outline of cardiopulmonary bypass circuit components and an overview of common technical issues that diminish the adequacy of perfusion, and to direct the team to resources available in order to achieve evidence-based clinically safe cardiopulmonary bypass.
Acute care and failure to rescue
Authors: Creed Fiona
Published: February 2021

The last decade has seen significant changes in management and care of patients in the United Kingdom who are acutely ill. Increasing pressures on hospital beds has meant the patients are discharged earlier and sometimes admitted later to the hospital environment, resulting in an overall increased acuity in hospital wards. This chapter discusses the factors that have impacted upon the delivery of acute care in hospital environments. It looks at the concept of failure to rescue and the role of human factors in delivery of patient care. It explores the need for an increased focus on patient safety in acute care and considers tools that can facilitate the delivery of effective patient care.
Neurological care
Authors: Creed Fiona
Published: February 2021

This chapter explores neurological acute care and includes discussion of normal physiology and physiological changes following illness and injury. In order to understand how to assess and manage the patient with neurological conditions it is essential to have an understanding of the structure and function of the brain and how injury/illness can affect this. Additionally, the chapter explains the importance of accurate and timely neurological assessment and specific nursing care of patients with neurological injury. It emphasizes the need for prompt intervention and appropriate escalation if patients exhibit signs of deterioration. Common neurological conditions of stroke, head injury, and epilepsy are discussed.
Pain assessment and management in acute care
Authors: Caddye Wendy
Published: February 2021

This new chapter highlights the importance of recognizing, assessing, and managing patients in pain safely in the acute care setting, and particularly when they are acutely ill. It explains pain theories, the importance of assessment and management of pain and explores the use of pharmacological, non-pharmacological and invasive analgesic techniques during acute care: which include the use of patient controlled analgesia (PCA); and regional analgesia including spinals, epidurals and continuous perineural blockade (CPNB). The use of intravenous lidocaine and plasters are also discussed.
Systematic assessment, early warning scores, and patient escalation
Authors: Creed Fiona
Published: February 2021

The need to rapidly assess and understand signs and symptoms of a patient whose condition is deteriorating is an essential skill for all health care professionals. The use of an A–E assessment approach and use of a standardized handover tool is emphasized throughout the literature. This chapter explores the systematic, accurate assessment, treatment, and escalation of the patient whose condition is deteriorating. It focuses upon the use of A–E methodology linked to standardized track-and-trigger scoring systems (NEWS2) and explains the significance of changes in observation findings during episodes of acute illness. The need for urgent escalation and the use of response teams is discussed.
Planning for emergency care and treatment when recovery is uncertain
Authors: Kemsley Kate
Published: February 2021

Managing patients with chronic and frailty conditions is complex and planning their goals of care and treatment may need adapting, particularly for an acute deterioration. Equally the family will need considerable support and robust communication strategies are imperative in these situations. This chapter highlights the importance of good leadership, decision-making, and care planning for patients within the context of the multidisciplinary team. This chapter explores the more complex process of advanced assessment, planning, and communication skills that may be required when caring for acutely ill adults. It discusses ethical dilemmas where treatment is withdrawn or withheld. The chapter explains the role of the acute care nurse as an essential member of the healthcare team and as an advocate for the patient and family.
Septic shock in children
Authors: Raman Sainath , Peters Mark J.
Published: February 2021

Chapter 1 begins by examining the definitions of sepsis and septic shock as subsets of the systemic inflammatory response syndrome, discusses the epidemiology of paediatric sepsis, and provides a structured approach to the assessment of a child with suspected sepsis. The evidence for and limitation of investigations, such as lactate measurement and attempted quantification of cardiac function in paediatric sepsis, is examined. Optimal management strategies for paediatric sepsis remain much studied and debated. This chapter addresses the use of inotropes—both early inotropes and choice of inotropes, intravenous fluids, including the current evidence base for choice of fluids, and the increasingly studied areas of fluid overload and fluid removal (de-resuscitation) following the initial phases of resuscitation. The evidence base for use and timing of antibiotics and steroids is discussed, along with the roles of the supportive therapies renal replacement therapy and extracorporeal membrane oxygenation. Finally, the chapter examines some of the key aspects of the care of patients with sepsis of relevance to intensivists: early goal-directed therapy; sepsis bundles; and the Surviving Sepsis Campaign.
Acute kidney injury
Authors: Bholah Reshma , Bunchman Timothy E.
Published: February 2021

Acute kidney injury (AKI) affects roughly one-quarter of children in the Intensive Care Unit and is associated with increased morbidity and mortality. Progress made in classifying paediatric AKI has allowed for better recognition of this entity. Consideration of degree of fluid overload and other risk factors for mortality should influence the choice to initiate renal replacement therapy. And while not all patients with AKI will require renal replacement therapy, the modality needs to be chosen carefully. This book chapter aims to describe AKI, provide a brief overview of the aetiology and diagnosis of this process, describe biomarkers under study for diagnosing AKI, compare the modalities of renal replacement therapy, and touch upon prognostic factors and recent advances in the field.
The stem cell transplant patient in the Paediatric Intensive Care Unit
Authors: Aziz Omer , Agbeko Rachel
Published: February 2021

Patients admitted to the Paediatric Intensive Care Unit after complications related to stem cell transplantation have high morbidity and mortality. Given the severity of immune dysfunction and dysregulation, this subset of patients are uniquely prone to a variety of infectious and non-infectious complications. Infections may be bacterial, viral, and fungal; non-infectious causes may include thrombotic microangiopathy, graft-versus-host disease, and idiopathic pulmonary syndrome. The importance of preventing/treating fluid overload and aggressive organ support strategies are discussed. In addition, this chapter also reminds clinicians that the patient and family are to be seen as partners in dialogue and decision-making. In the unfortunate situation where the prognosis appears bleak, the most appropriate course of action may involve frank discussions with the patient, family, and wider team members about the pros and cons of further escalation strategies.
Low cardiac output state in a postoperative cardiac patient
Authors: Ghose Arun , Plunkett Adrian
Published: February 2021

Chapter 13 covers the low cardiac output state (LCOS) in children following cardiac surgery. It begins by explaining how LCOS is defined, risk factors for its development, and how to assess and investigate a child with LCOS. The role of echocardiography is discussed, and the limitations of other measurement techniques are examined. Modifiable causes of LCOS in postoperative cardiac surgical patients are examined, including residual cardiac lesions and arrhythmias—and their management discussed. Important physiological concepts in the understanding of LCOS are addressed, including preload, afterload, systolic and diastolic function, and fluid responsiveness. Finally, options for managing patients with LCOS are covered, including the role of drugs, surgery, and extracorporeal membrane oxygenation.
Inherited metabolic disorders in the Paediatric Intensive Care Unit
Authors: Sangaran Dilanee , Champion Mike
Published: February 2021

Children presenting to intensive care with undiagnosed inherited metabolic diseases (IMDs) can pose a significant diagnostic and management challenge to intensivists. This chapter covers the range of presentations of IMDs in neonates in particular, addressing important points to be raised in the history and assessment of children suspected of these conditions—including perinatally. The main subgroups of IMD presenting in the neonatal period are explained: intoxication; energy deficiency; making and breaking complex molecules and seizures; and important differentiating features noted. Baseline investigations of a suspected IMD are listed, and the importance of considering and testing for hyperammonaemia discussed. The emergency treatment of acute crisis or first presentation of IMDs is set out, which includes calculating appropriate glucose intake. Finally, the chapter discusses the role of continuous veno-venous haemofiltration in hyperammonaemia and the option of liver and hepatocyte transplantation in severe recurrent cases.
Nutritional considerations in the Paediatric Intensive Care Unit
Authors: Albert Ben D. , Ariagno Katelyn , Mehta Nilesh M.
Published: February 2021

This chapter provides the readers with an exhaustive overview of several key issues and challenges surrounding nutrition in critically ill children. This chapter covers basic concepts such as obtaining a nutritional history, assessment of nutritional status, and obtaining anthropometric measurements. This then leads on to further advanced concepts, including the role of parenteral nutrition, postpyloric enteral feeding, estimating energy requirements, indirect calorimetry, refeeding syndrome, and so on. The authors summarize the evidence base around controversial issues such as enteral feeding while on vasoactive infusions. This chapter stresses the importance of promoting and establishing enteral feeding, and provides the readers with tips to implement evidence-based practice.
Cancer Immunotherapy in Children
Authors: Hirabayashi Koichi , Dotti Gianpietro , Savoldo Barbara
Published: February 2021

This chapter discusses the principle of cancer immunotherapy in children and adolescents, starting with the most common form of cellular immunotherapy: allogeneic haematopoietic stem-cell transplantation (HSCT). It then discusses specific immunotherapy strategies based on the administration of classic monoclonal antibodies (mAbs) targeting tumour-associated antigens, novel bispecific antibodies that simultaneously target tumour-associated antigens and activate CD3+ T lymphocytes, and mAbs that block key inhibitory molecules of the immune system (checkpoint blockade). Finally, the chapter describes specific cellular immunotherapy approaches, such as tumour vaccine and adoptive transfer of immune cells. Although only a few immunotherapies have so far been incorporated into the standard practice for paediatric cancers, their role is enjoying a new revival, after the promising results obtained in recent clinical trials.
Germ-Cell Tumours
Authors: Calaminus Gabriele , Nicholson James C.
Published: February 2021

Germ-cell tumours (GCT) comprise a heterogeneous group of tumours, occurring mainly in children, adolescents, and young adults, which vary by site, range of histological subtypes, and behaviour. Gonadal sites, testes, and ovaries account for around two thirds of extracranial GCT, the remainder occurring at extragonadal sites. Histological components range from mature benign teratoma to malignant subtypes, germinoma, yolk sac tumour, choriocarcinoma, and embryonal carcinoma. Raised levels of the tumour marker alphafetoprotein (AFP) in yolk sac tumours, and human chorionic gonadotrophin (HCG) in choriocarcinoma and, to lower levels, in germinoma/dysgerminoma/semi-noma, assist with diagnosis and are useful for monitoring response to treatment and in follow-up. Genomic and transcriptomic analysis provide some insight into the nature of GCT, with common patterns of chromosomal imbalance identified, and distinguish between adult and paediatric GCT with respect to their messenger RNA-expression patterns. Patterns of microRNA expression, common to malignant GCT, across all age groups and histological subtypes, have also been identified in both tumour and serum, where they have potential for use in non-invasive diagnostics and monitoring. Management of teratoma is surgical, and completely resected stage 1 malignant GCT can also be managed with resection followed by close observation. Higher-stage malignant tumours warrant adjunctive chemotherapy following diagnosis. Unresectable tumours may be managed with neoadjuvant chemotherapy and delayed resection. Chemotherapy strategies employ platinum-containing combinations. Outcomes are excellent in the majority of cases, so the goal of new treatment strategies is mainly focused on minimizing late effects of treatment. Many relapses can be salvaged with further chemotherapy.
Neuropathology
Authors: Attems Johannes , Jellinger Kurt A.
Published: February 2021

This chapter describes the main neuropathological features of the most common age-associated neurodegenerative diseases, including Alzheimer’s disease, Parkinson’s disease, and dementia with Lewy bodies, as well as other less frequent ones such as multiple system atrophy, Pick’s disease, corticobasal degeneration, progressive supranuclear palsy, argyrophilic grain disease, neurofibrillary tangle-dominant dementia, frontotemporal lobar degeneration with TDP-43 pathology, and Huntington’s disease. Likewise, cerebral amyloid angiopathy, hippocampal sclerosis, vascular dementia, and prion diseases are described. A main aim of this chapter is to assist the reader in interpreting neuropathological reports; hence criteria for the neuropathological classifications of the major diseases are provided. One section covers general considerations on neurodegeneration, and basic pathophysiological mechanisms of tau, amyloid-β‎, α‎-synuclein, TDP-43, and prions are briefly described in the sections on the respective diseases. Finally, one section is dedicated to cerebral multimorbidity, and a view on currently emerging neuropathological methods is given.
Physical assessment
Authors: Harwood Rowan H , Cowan Rachel
Published: February 2021

Physical and mental health problems in older people often co-exist, and may be inter-related. This chapter explores the use of the Comprehensive Geriatric Assessment (CGA) to holistically address the impacts of multiple physical and psychiatric comorbidities on older peoples’ health and function. Older people with mental health problems are particularly vulnerable to frailty and the impacts of polypharmacy. They may present with atypical complaints, are prone to complications, and are at risk of quickly losing their functional abilities. A period of rehabilitation is often necessary to restore functioning after an episode of illness. Multidisciplinary working is essential to offer holistic management of problems commonly seen in older people, including immobility, falls, confusion and incontinence. A focus on person-centred care is particularly important for people living with dementia, and this chapter describes an approach to healthcare that promotes open communication with patients and carers, shared decision-making, and advance care planning.
Neuroimaging
Authors: Suri Sana , Valkanova Vyara , Heise Verena , Sexton Claire E. , Ebmeier Klaus P.
Published: February 2021

Neuroimaging provides a way of examining the structure and function of the brain in life. This chapter gives an up-to-date summary of the methods employed in research and clinic, what is involved for the patient in taking part in imaging, and both current clinical applications as well as those about to enter general old age psychiatry practice. Magnetic resonance imaging and imaging with ionizing radiation, such as X-ray computed tomography (CT), single photon emission computed tomography (SPECT), and positron emission tomography (PET), are covered. Additionally, it provides a short summary of the applications and potential of electro- and magnetophysiological techniques. It summarizes the current and potential use of neuroimaging methods in diagnosis, prognosis, understanding illness mechanisms, and the brain mechanisms that confer resilience against the brain diseases of old age.
Cognitive behavioural therapy
Authors: Laidlaw Ken , Wilkinson Philip
Published: February 2021

Cognitive behaviour therapy (CBT) is a dominant psychological treatment in the management of a range of psychiatric disorders and is increasingly being refined to suit the needs of older adults. This chapter summarizes the theory and practice of CBT, and emphasizes assessment, formulation, and adaptation of treatment with older patients. It describes in detail management of depressive disorder, anxiety disorders and dementia caregiver distress and includes relevant case examples. It also covers problem-solving therapy and behavioural activation. The chapter also describes mindfulness-based cognitive therapy (MBCT), which has potential benefits in the treatment of older adults, and it reviews applications with older people. It outlines newer applications, including treatment of psychological symptoms associated with physical illness, psychosis, and memory impairment. Finally, it describes how the evidence base for CBT-based interventions with older adults is limited and reviews the extent of the current evidence.
Interpersonal psychotherapy
Authors: Wilkinson Philip , Laidlaw Ken
Published: February 2021

This chapter on interpersonal psychotherapy (IPT) describes the theory and practice of this structured psychological treatment. It discusses the implementation of IPT with older people. Next it reviews the applications of IPT with a main focus on the treatment of depression in older adults and distinguishes between the treatment of depression with and without cognitive impairment. It summarizes the structure of IPT and the use of specific techniques, and it then addresses the main therapeutic foci encountered in treatment (grief, interpersonal role disputes, role transitions, and interpersonal deficits). Finally, it briefly reviews the evidence base for IPT with older people.
Non-pharmacological interventions in care homes, with particular emphasis on the treatment of people with dementia
Authors: James Ian A. , Howarth Alan
Published: February 2021

In the UK there are over 22,000 care homes, largely run by the private and charitable sectors, caring for 416,000 people. The residents in care homes present with a range of needs linked to physical health, cognitive health, and mental health. A large proportion of residents in care homes have dementia and many of them exhibit Behaviours that Challenge (BtC). This chapter focuses on the non-pharmacological interventions available in care homes to help treat BtC that occur in the context of dementia. It discusses preventative interventions designed to promote the wellbeing of people with dementia, and reviews the evidence. Formulation-led interventions identify the needs of the individual and lead to the development of person-centred care plans and the evidence strongly supports that these are needed to deliver effective psychosocial interventions in care homes. Finally, the chapter discusses the implications for future research.
Psychiatric presentations among older people living in low- and middle-income countries
Authors: Jacob K. S , Ferri Cleusa P.
Published: February 2021

Psychiatric presentations among older people living in low- and middle-income countries (LMICs) and their management pose many challenges. However, population ageing, which is being seen across nearly all countries and cultures and is the most significant social transformation of the twenty-first century, continues to receive limited attention and resources in LMICs. While the syndrome approach (with its inherent clinical heterogeneity) currently employed by international psychiatry is used in LMICs, the differences in environmental milieu mandate a contextual understanding. This chapter reviews common psychiatric presentations among older people with a focus on similarities and differences between LMICs and high-income countries (HICs), in order to achieve a contextual understanding of diagnosis and management across settings. It discusses dementia, mild cognitive impairment (MCI), delirium, late-onset psychosis, depression, anxiety, suicide, and substance use, and highlights issues related to burden of care, culture, and health systems. It emphasizes social, economic, political, and cultural contextual understanding.
Social care
Authors: Moriarty Jo
Published: February 2021

Social care is the broad term for the support provided to people living at home and in care homes. Major changes have taken place to this sector in the past few years and this chapter describes the key policy developments that have impacted upon the kind of support provided to older people with mental health problems and how that support is funded. The policy of personalization is intended to increase choice and control, but as yet it is unclear whether this will lead to improved outcomes in terms of quality of life or independence. Some long-standing issues, such as the high prevalence of people with unidentified mental health problems in long-term care, continue to provide challenges for organizations providing social care support.
Alzheimer’s disease
Authors: Taylor John-Paul , Underwood Benjamin R
Published: February 2021

Dementia is the fifth leading cause of death worldwide. The most common cause of dementia is Alzheimer’s disease (AD). This fully updated and revised chapter comprehensively reviews the latest evidence on diagnosis, assessment, investigations, clinical features, management, risk factors, prognosis, and future potential treatments for AD. Importantly, the chapter explores newer evidence that has changed the way AD is viewed as regards methods of assessment using various scales to determine diagnosis, as well as current and investigative methods of treating AD. Finally, it looks at the states of disease progression, potential disease-modifying drugs for Alzheimer’s disease, and possible therapeutic approaches to treatment and management.
Vascular and mixed dementia
Authors: Stewart Robert
Published: February 2021

Vascular disease is the most important environmental risk factor for dementia but this research area has been hampered by inadequate outcome definitions—in particular, a diagnostic system that attempts to separate overlapping and probably interacting pathologies. There is now substantial evidence that the well-recognized risk factors for cardiovascular disease and stroke are also risk factors for dementia, including Alzheimer’s disease. However, these risk factors frequently act over several decades, meaning that the chances of definitive randomized controlled trial evidence for risk-modifying interventions are slim. This should not obscure the wide opportunity for delaying or preventing dementia through risk factor control and uncontroversial healthy lifestyles. Care should also be taken that comorbid cerebrovascular disease is not considered as excluding a diagnosis of Alzheimer’s disease, particularly now that this determines treatment eligibility.
Frontotemporal dementia
Authors: Bocchetta Martina , Rohrer Jonathan D
Published: February 2021

The term frontotemporal dementia (FTD) describes a heterogeneous group of neurodegenerative disorders with multiple genetic and pathological causes. However, there is sufficient overlap both clinically, in terms of behavioural and/or language difficulties, and anatomically, with neuronal loss occurring in the frontal and temporal lobes, that the conditions are commonly considered together as one group. Overall, the FTD disorders represent a common cause of early-onset dementia, approximately equal in frequency to Alzheimer’s disease in people under the age of 65. The only known risk factors are genetic, and about a third of cases are due to an autosomal dominant mutation. No curative treatment is currently available and symptomatic and supportive care is the mainstay of management. This chapter discusses the concept of FTD, describing its clinical presentation, genetics, neuropathology, neuroimaging, fluid biomarkers, and management.