bluuebunny/crossref_metadata_2025 huggingface dataset:
Screening for anxiety disorders
Authors: Wittchen Hans-Ulrich , Boyer Patrice
Published: August 2018

Background The paper describes the rationale, sensitivity and specificity of the Anxiety Screening Questionnaire (ASQ), a disorder-specific screening instrument for use in primary care.

Method Two hundred and fifty subjects sampled from psychiatric, primary care settings and the community, participated in a test-retest reliability as well as a procedural validity study, using the M–CIDI with DSM–IV algorithms as a diagnostic yardstick.

Results The ASQ was found to be easy to administer and acceptable and efficient in terms of sensitivity and specificity for generalised anxiety syndromes. The test– retest item reliability was good to excellent with kappa values of 0.6 or above. As compared with the validity standard, the DSM – IV/CIDI diagnoses caseness sensitivity was generally high (above 82%) for all diagnostic domains covered, whereas the specificity was only high for DSM – IV threshold and subthreshold generalised anxiety disorder.

Conclusions These preliminary findings demonstrate the usefulness of this anxiety screening questionnaire, constructed closely following the guidelines of specific diagnostic criteria.
Interaction of pharmacological and psychological treatments of anxiety
Authors: Lader M. H. , Bond A. J.
Published: August 2018

Background Pharmacological and psychological treatments for anxiety are often combined in clinical practice but there is little research from which to predict the effects.

Method The theoretical outcomes of combining treatments and methods of investigating these as well as methodological difficulties are described. Studies which have been completed in anxiety disorders are reviewed. A double-blind trial, using a factorial design, evaluated buspirone v. placebo and anxiety management training v. nondirective therapy in 60 patients with generalised anxiety disorder (GAD).

Results Relatively few germane studies have been carried out in the anxiety disorders except for panic disorder with agoraphobia. There is some evidence that short-term, combined treatment does confer additional benefits which are evident both in speed of onset and lasting remission. All four treatment combinations proved effective in the short-term treatment of GAD.

Conclusions More studies examining combined treatment are needed. Although differences may not be apparent at the end of the treatment period, psychological treatment appears to confer advantages at follow-up.
Cholinergic aspects of schizophrenia
Authors: Tandon Rajiv
Published: August 2018

While increased dopamine activity is central to our current understanding of the pathophysiology of schizophrenia, dysregulation of a single neurotransmitter is unlikely to explain the disorder adequately. It is argued here that the muscarinic aspects of schizophrenia should be reassessed for a number of reasons. These include current evidence that cholinergic modulation affects both positive and negative symptoms, and neuroendocrine and polysomnographic data that suggest an increased muscarinic cholinergic activity in schizophrenia. In addition, the interactions between the dopaminergic and cholinergic systems are becoming better understood and appear to occur especially in regions that are thought to be relevant in schizophrenia. The fact that the highest affinity of clozapine, with its unique therapeutic profile, is to the muscarinic receptor encourages further evaluation. Finally, the use of anticholinergic agents to treat extrapyramidal side-effects and the fact that many antipsychotic agents have intrinsic anticholinergic activity suggest that the role of the cholinergic system in schizophrenia needs to be more clearly delineated.
Field Trials of the 1987 Draft of Chapter V (F) of ICD-10
Authors: Burke Jack D.
Published: August 2018

Introduction

This paper will review the major objectives and study design of the Field Trials of the draft chapter on Mental Behavioural and Developmental Disorders in the tenth revision of the International Classification of Diseases (ICD-10), now in preparation. The text used in this Field Trial is the Clinical Descriptions and Diagnostic Guidelines, which is more elaborate than the Short Glossary for this chapter that will be published in the main volume of ICD-10. The text for the former will be published together with the Diagnostic Criteria for Research and other parts of the WHO family of instruments relevant to mental health.
Non-Cognitive Symptoms and the Diagnosis of Dementia
Authors: Berrios G. E.
Published: August 2018

The current characterisation of dementia as a state of global cognitive failure (DSM-III-R, 1987) cannot differentiate it reliably, in cross-sectional diagnosis, from other states of compromised cognition. This is likely to contribute to both the over- and under-diagnosis of dementia in clinical practice (Marsden & Harrison, 1972; Fleminger, 1975; Ronet al, 1979; Smith & Kiloh, 1981; Garciaet al, 1984; Kleinet al, 1985). However, diagnostic discrimination between true dementia and its behavioural phenocopies (e.g. depressive pseudo-dementia, quiet delirium, etc.) can be improved in a number of ways. One such is the longitudinal assessment of symptom-clusters (e.g. those related to memory, personality, and cortical syndromes); another is the inclusion of new symptoms into the definition of dementia. The first of these strategies has been given more attention than the second.
Obsessive-Compulsive Disorders in Cambridgeshire
Authors: Berrios G. E. , Chiu H.
Published: August 2018

Obsessive-compulsive disorders (OCDs) (ICD-9 = 300.3) (ICD-9, 1978) remain an obscure, heterogeneous, and often unmanageable collection of interfering and repetitive experiences and actions which may interrupt, and occasionally obliterate the flow of behaviour (Beech, 1974; Rachman & Hodgson, 1980; Berrios, 1985; Jenike et al, 1986). Considered during the 19th century as a form of psychosis, OCDs were incorporated at the turn of the century into the psychodynamically redefined class of the ‘neuroses’ (Berrios, 1985). However, this newly gained identity has proved to be heuristically sterile as well as delaying research.
The Biases of Psychiatric Diagnosis
Authors: Guimón José
Published: August 2018

Psychiatric diagnosis tests the hypothesis that particular signs and symptoms, when regularly found together, belong to a particular class. The class concerned, in turn, is usually part of a taxonomic system, and which system one chooses will depend on the aim and function of diagnosis (treatment, research, administration, etc.). Diagnosis and classification involve a loss of information, the magnitude of which is determined by both the use to which the diagnosis has been put and the assumptions and theoretical orientation of the clinicians involved in the exercise.
The Concept of Perversion in Psychoanalysis
Authors: Etchegoyen R. H.
Published: August 2018

Freud's Three Essays on the Theory of Sexuality (1905) made possible the understanding of the concept of perversion as a form of psychic conflict resulting from both constitutional and acquired factors. He stated (as against earlier views) that sexual deviations could not be separated from ‘normal’ sexual behaviour, on the grounds that both sprang from a common source (infantile sexuality). In the first essay, Freud classified sexual deviations into two groups, depending on whether the aim (e.g. sadism and masochism) or the object of the instinct (e.g. homosexuality and paedophilia) were displaced. In the second essay he characterised infantile sexuality as a collection of partial instincts and erotogenic zones, on which both the source and the object of the instinct converged. He also stated that infantile sexuality was auto-erotic, implying that the sexual object was contingent.
VIII. Ethnic Aspects. A Comparison of Three Matched Groups
Authors: Perera R. , Owens D. G. C. , Johnstone Eve C.
Published: August 2018

In recent years there has been increasing interest in the sociocultural aspects of psychiatric disorders, particularly schizophrenia (World Health Organization, 1975; Sartorius et al, 1986). This has extended from multicentre international studies of prevalence, through national incidence or phenomenological studies in different ethnic groups (Cochrane, 1977; Teggin et al, 1985), to outcome assessments in different cultures (Sartorius et al, 1986, 1987).
The Vulnerability of the Hippocampus to Protective and Destructive Effects of Glucocorticoids in Relation to Stress
Authors: McEwen Bruce S. , Gould Elizabeth A. , Sakai Randall R.
Published: August 2018

The pituitary—adrenal axis participates in the diurnal response of the organism to the environment and in its response to stress. Circulating glucocorticoid and mineralocorticoid hormones act on cells in the brain via Type I and Type II receptors, which operate at the level of gene regulation, and mediate various feedback effects of adrenal steroids on brain chemistry and structure, including the operation of second-messenger generating systems, levels of structural proteins of glial cells, and the death and survival of neurons. The hippocampus is prominent in these effects, and it also displays the highest level of Type I receptors of any brain region. New concepts point to a special role of the hippocampus, a nexus of cognition and emotion, in the feedback actions of adrenal steroids during the diurnal rhythm, and in response to stress. The hippocampus is, therefore, a prime target area for investigation of the events which accompany stress, and which may be related to the maladaptive state that results in depressive illness. Initial studies are described which investigate the effects of tianeptine on pituitary—adrenal function, hippocampal morphology and Type I and Type II receptor levels.
Glucocorticoids, Transmitters and Stress
Authors: Delbende C. , Delarue C. , Lefebvre H. , Bunel D. Tranchand , Szafarczyk A. , Mocaër E. , Kamoun A. , Jégou S. , Vaudry H.
Published: August 2018

Many kinds of stress stimulate the neuroendocrine systems controlling catecholamine and glucocorticoid secretion. Stress-induced stimulation of CRF-containing neurons appears to be mediated by serotonergic, noradrenergic, and possibly other neuronal pathways. Stress can alter various neurobiological and endocrine functions, two essential components of the neuroendocrine responses being release of adrenalin from chromaffin cells of the adrenal medulla and secretion of glucocorticoids from adrenocortical cells. Activation of adrenal steroid secretion is mainly by a reflex activation of hypothalamic neurons, which stimulate ACTH secretion from the anterior pituitary. While the neuropeptide CRF plays a major role in the neuroendocrine response to stress, the neuronal signals which are responsible for the regulation of CRF neurons have not been completely elucidated. A number of other regulatory substances may also participate, alone or with CRF, in the control of ACTH secretion by pituitary corticotrophs, and there is increasing evidence that classical neurotransmitters or neuropeptides may act directly on adrenocortical cells to modulate corticosteroid secretion. We review the neuronal, neuroendocrine, and humoral pathways which participate in the regulation of stress-induced corticosteroid secretion, and present preliminary data on the effect of the tricyclic antidepressant, tianeptine in the response of the HPA axis to stress.
Dimensions of Outcome with Clozapine
Authors: Meltzer Herbert Y.
Published: August 2018

Various outcome measures following clozapine administration to neuroleptic-resistant schizophrenic patients are considered. The importance of a multidimensional perspective is emphasised. There was significant improvement in positive symptoms, some negative symptoms, quality of life, some types of cognitive function (e.g. semantic memory), extrapyramidal function, and tardive dyskinesia. Readmission to hospital, and family burden were markedly reduced, which achieved significant savings in the cost of treatment. Compliance with clozapine and weekly blood testing can be achieved in the majority of treatment-resistant cases. These benefits may occur independently of each other.
Cardiovascular Effects of Antidepressant Medications
Authors: Halper James P. , Mann J. John
Published: August 2018

Antidepressants are associated with a variety of side-effects, ranging in severity from the merely annoying to those with significant morbidity and even potential mortality. Prominent among the latter are cardiovascular effects, which have provided much of the impetus for the development of newer antidepressants such as fluoxetine. In this paper, we will review these cardiovascular effects, but as this has been previously undertaken elsewhere (e.g. Glassman & Bigger, 1981; Marshall & Forker, 1882; Glassman, 1984a), our consideration will be selective, with emphasis on methodological issues of relevance to the evaluation of new antidepressants. Since mechanisms of cardiac side-effects are best understood in relation to tricyclic antidepressants (TCAs), these will be a major focus, and will provide a background for the consideration of newer agents.

While less is known regarding the side-effects of the newer antidepressants, examination of the evolution of knowledge and opinions regarding their safety is particularly pertinent in that it illustrates the waxing and waning of enthusiasm that typically accompanies the introduction of new therapeutic agents. We review below the growing body of data regarding fluoxetine and some of the other serotonin-selective antidepressants, as well as discussing serotonergic effects on the cardiovascular system and their implications for the clinical use of these agents. Since the interactions between antidepressants and drugs used to treat cardiovascular disorders have been reviewed by Rischet al(1982) and Glassman & Salzman (1987), these will not be considered here.
Tyramine and Irreversible Monoamine Oxidase Inhibitors in Clinical Practice
Authors: Cooper A. J.
Published: August 2018

The cheese reaction following use of the irreversible monoamine oxidase inhibitors (MAOIs) began to be reported in the UK with increasing frequency from about 1961. By 1965, the underlying mechanism (tyramine-provoked hypertension) had been essentially elucidated. Thereafter, this potentially severe side-effect could have been largely avoided by the use of fairly simple dietary precautions. Unfortunately, suspicion and fear burgeoned, and both the seriousness and the frequency of risk were dramatically inflated. This was a major factor in the subsequent general disuse of the irreversible MAOIs. Second-generation MAOIs which are selective for monoamine oxidase-A and B are now being synthesised and may eliminate the eventuality of hypertension without special dietary precautions.
Biochemical Aspects of the Pharmacology of Moclobemide
Authors: Callingham B.A.
Published: August 2018

Administration of moclobemide – a relatively short-acting, reversible inhibitor of monoamine oxidase-A (MAO-A) – to experimental animals potentiates the pressor responses to intravenously injected tyramine, but such effects are moderate, short-lived, and much less apparent when the tyramine is given orally. The ability of moclobemide to potentiate the pharmacological actions of amine substrates for MAO-A in in vitro preparations is very weak, unless the drug is ‘activated’ by prior incubation with the tissues. However, animal experiments, both in vitro and in vivo, can give realistic indications not only of the mode of action of inhibitors of MAO and any toxicity, but also, in the case of MAO inhibitors, of the chance of potentially life-threatening hypertensive crises following inadvertent ingestion of amine-containing food or medicaments. Animal tests may also reveal any influence MAOIs have on amines released from non-neuronal stores.
Hillside study of risk and early detection in schizophrenia
Authors: Cornblatt Barbara , Obuchowski Michael , Schnur David , O'Brien John D.
Published: August 2018

BackgroundThe Hillside Study of Risk and Early Detection in Schizophrenia is a prospective study of young probands (ages 14–28) and their at-risk siblings (ages 14–24). A major goal is the identification of early predictors of illness that will facilitate intervention. The project design and pilot study are discussed.

MethodFifteen adolescents were compared to 14 typical age-of-onset adults, all undergoing their first hospitalisation for schizophrenia.

ResultsThere were no differences between adolescents and adults on any of the measures administered (i.e. attention, eye tracking, neurocognitive or clinical). In addition, for the sample overall, no association was found between neurocognitive functions and clinical state, either at admission or after treatment.

ConclusionsIndividuals with adolescent onset of schizophrenia are considered to be representative of schizophrenia in general. Furthermore, neurocognitive deficits and clinical symptoms are concluded to be two independent classess of risk indicators.
First-episode schizophrenia
Authors: Wyatt Richard Jed , Damiani L. Michelle , Henter Ioline D.
Published: August 2018

BackgroundThe concept that early intervention with antipsychotic medications improves the long-term course of schizophrenia is discussed.

MethodThis report reviews the literature concerning early intervention with antipsychotic medications for people with firstepisodes, and how it affects long-term morbidity. It also studies the effects of discontinuing antipsychotic medications on relapse for people with first episodes.

ResultsEarly intervention with antipsychotic medications appears to decrease the long-term morbidity of schizophrenia.

ConclusionsEarly intervention with antipsychotic medications should be encouraged for people experiencing their first episode of schizophrenia. This report proposes that studying the various phases of subject response to treatment can be helpful in elucidating when antipsychotic medications should be tapered or withdrawn.
Prolonged recovery in first-episode psychosis
Authors: Edwards Jane , Maude Dana , McGorry Patrick D. , Harrigan Susan M. , Cocks John T.
Published: August 2018

Background Early identification and specialised treatment of individuals with enduring positive symptoms may assist in alleviating symptoms and has the potential to change the course of illness.

Method Prevalence and descriptive data on enduring positive symptoms in two first-episode samples are outlined. Attempts to incorporate the focus of early intervention for persisting psychosis into routine clinical care of individuals with first-episode psychosis are described.

Results Of the 227 individuals with first-episode psychosis who were assessed using the Brief Psychiatric Rating Scale at 3/6 months and 12 months following initial stabilisation (from a total sample of 347), 6.6% experienced enduring positive symptoms at all three time points. When the analysis was restricted to schizophrenia, schizophreniform and schizoaffective disorders (n=158) the percentage increased to 8.9%. These patients had significantly longer mean duration of untreated psychosis prior to initiation of treatment and, at 12-month follow-up, significantly higher depression and poorer psychosocial functioning.

Conclusions The association of untreated psychosis with treatment resistance supports the argument for early intervention as soon as possible following the onset of psychotic symptoms.
Neuroanatomical aspects of cognitive-behavioural therapy response in obsessive-compulsive disorder
Authors: Schwartz Jeffrey M.
Published: August 2018

BackgroundRecent research has demonstrated that cognitive-behavioural therapy (CBT) for obsessive-compulsive disorder (OCD) can systematically modify cerebral metabolic activity in a manner which is significantly related to clinical outcome.

MethodA substantial body of research is reviewed which supports an involvement of neural circuitry connecting the orbitofrontal cortex, cingulate gyrus and basal ganglia in the expression of the symptoms of OCD.

ResultsData are presented which expand upon previous work demonstrating effects of CBTon functional interactions between limbic cortex and the basal ganglia.

ConclusionsThe relevance of these effects of CBTon brain function is discussed in the context of recent advances in our knowledge of cortical–basal ganglia physiology. The clinical importance of these data is best appreciated when they are seen to reflect the interactive nature of the relationships between cognitive choice, behavioural output and brain activity.
Building castles on sands or quicksands?
Authors: Maynard Alan , Bloor Karen
Published: August 2018

Economic evaluations of new and existing pharmaceutical products are an essential input into decision-making in health care. Health care systems around the world face steady increases in the total cost of pharmaceuticals. Increasingly, health care funders have to choose which drugs are subsidised and which are not reimbursed from public funds. In psychiatry, a number of new pharmaceutical products have recently been developed for the treatment of depression and schizophrenia which cost considerably more than traditional pharmacological products. Governments and purchasers, with limited budgets and expanded demands for funding, require pharmaceutical companies to demonstrate the cost-effectiveness of their new therapies. It is no longer sufficient to consider the clinical or therapeutic effects of new drugs: purchasing choices are predicted on studies which identify, measure and value what is given up when a product is used (the cost) and what is gained (improved health outcome).
Pre-clinical Pharmacology of Atypical Antipsychotic Drugs: A Selective Review
Authors: Meltzer Herbert Y.
Published: August 2018

The primary basis for the action of neuroleptic drugs has been suggested to be a blockade of D2receptors in the mesolimbic system, with subsequent decrease in the firing rate of ventral tegmental (A10) dopamine neurons by the process of depolarisation inactivation (Matthyssee, 1974; Bunneyet al, 1991). The main evidence for this hypothesis is that: the affinities for the D2receptor of all effective antipsychotic drugs are positively correlated with their average clinical dose (Seeman & Lee, 1975; Creeseet al, 1976); and chronic administration of antipsychotic drugs produces nearly complete inhibition of the firing of ventral tegmental (A10) dopamine neurons that project to the limbic forebrain (Chiodo & Bunney, 1983). Clozapine, the prototypical atypical antipsychotic drug, also satisfies both criteria (Seeman & Lee, 1975; Chiodo & Bunney, 1985). However, the demonstration that clozapine is more effective than other neuroleptics for the treatment of both schizophrenic patients who are responsive to typical neuroleptics (Meltzer, 1992) as well as those who are resistant (Kaneet al, 1988) suggests that this simple dopamine hypothesis of neuroleptic drug action is insufficient. Indeed, there is evidence that clozapine at clinically effective doses produceslessD2receptor occupancy and, hence, less antagonism of D2receptors in the striatum, and probably also in the limbic system, than typical neuroleptic drugs (Fardeet al, 1992); this further challenges the adequacy of the dopamine hypothesis to explain the greater efficacy of clozapine. This leaves the need to consider what else besides a D2receptor blockade may explain the action of clozapine and, indeed, whether limited blockade is superior to a more complete one.
ICI 204, 636: A New Atypical Antipsychotic Drug
Authors: Hirsch Steven R. , Link Christopher G. G. , Goldstein Jeffrey M. , Arvanitis Lisa A.
Published: August 2018

The therapeutic effects of ‘classic’ (typical) antipsychotic agents lie in their ability to block central dopaminergic receptors – a property that is also responsible for the frequent occurrence of undesirable extrapyramidal side-effects (EPS). In contrast to these typical agents, clozapine alone has distinguished itself in humans – by virtue of its enhanced antipsychotic action and lack of concurrent EPS – as an atypical antipsychotic. However, the use of clozapine has been limited by the occurrence of agranulocytosis and, to a lesser extent, seizures (Alvir et al, 1993; Haring et al, 1994). The mechanism underpinning the atypical profile of clozapine remains elusive. One hypothesis suggests that it lies in clozapine's higher serotonin 5-HT2: D2 binding ratio, when compared with typical agents – a factor being considered as a predictor of atypicality (Meltzer, this issue; Meltzer et al, 1989). However, an emerging view is that it is not a single pharmacological action, but rather multiple properties that may define an atypical, clozapine-like compound (Lieberman, 1993).
Social Factors and Comorbidity of Depressive and Anxiety Disorders
Authors: Brown G.W. , Harris T. O. , Eales M. J.
Published: August 2018

Differences in rates of depression across and between populations can be considerable and are largely determined by psychosocial factors. Such findings have important implications for comorbidity. On the basis of multiplying independent probabilities, the proportion of comorbid conditions increases as base rates of the disorders increase in a population. If such a chance combination has clinical implications, it would appear to be a “fact” of significance irrespective of biological underpinnings. In a recent survey of 404 women living with at least one child in an inner-city area, the rate of both anxiety and depression was highly related to the childhood experiences of neglect and abuse. However, adversity in adult life (e.g. widowhood or divorce), which might be expected to relate to current stressors, was only related to the rate of depression. The two risk factors had a considerable impact on comorbidity by increasing the rate of each disorder and thus the probability of their occurring together. They had a lesser impact as “common antecedents”. If both influences are considered, such adversity explains around half of the comorbidity. This is a conservative estimate of the impact of psychosocial factors.
Comorbidity and Boundaries of Affective Disorders with Anxiety Disorders and Substance Misuse: Results of an International Task Force
Authors: Merikangas K. R. , Angst J. , Eaton W. , Canino G. , Rubio-Stipec M. , Wacker H. , Wittchen H.-U. , Andrade L. , Essau C. , Whitaker A. , Kraemer H. , Robins L. N. , Kupfer D. J.
Published: August 2018

Associations between affective disorders, anxiety disorders, and substance use disorders were examined in epidemiological studies conducted in Germany, Switzerland, Puerto Rico, and the mainland US. There was a remarkable degree of similarity across studies in the magnitude and type of specific disorders associated with the affective disorders. Comorbidity with affective disorders was greater for the anxiety disorders than for substance misuse. Panic disorder was the subtype of anxiety that was most highly comorbid with depression. Social phobia was the specific phobic type with the strongest association with the affective disorders. The magnitude of associations between substance misuse and affective disorders generally was quite low and less consistent across sites. No major differences were found in the patterns of comorbidity by gender or age group, affective subtype or prevalence period. The onset of anxiety disorders generally preceded that of depression, whereas alcohol misuse was equally likely to pre- or post-date the onset of affective disorders. Finally, comorbidity was associated with an elevation in treatment ratesacross all sites, confirming Berkson's paradox on an international level.
Major Depression and Generalised Anxiety Disorder
Authors: Kendler Kenneth S.
Published: August 2018

In both clinical and epidemiological samples, major depression (MD) and generalised anxiety disorder (GAD) display substantial comorbidity. In a prior analysis of lifetime MD and GAD in female twins, the same genetic factors were shown to influence the liability to MD and to GAD. A follow-up interview in the same twin cohort examined one-year prevalence for MD and GAD (diagnosed using a one-month minimum duration of illness). Bivariate twin models were fitted using the program Mx. High levels of comorbidity were observed between MD and GAD. The best-fitting twin models, when GAD was diagnosed with or without a diagnostic hierarchy, found a genetic correlation of unity between the two disorders. The correlation in environmental risk factors was +0.70 when GAD was diagnosed non-hierarchically, but zero when hierarchical diagnoses were used. Our findings provide further support for the hypothesis that in women, MD and GAD are the result of the same genetic factors. Environmental risk factors that predispose to ‘pure’ GAD episodes may be relatively distinct from those that increase risk for MD.
Implications of Comorbidity for Genetic Studies of Bipolar Disorder: P300 and Eye Tracking as Biological Markers for Illness
Authors: Blackwood D. H. R. , Sharp C. W. , Walker M. T. , Doody G. A. , Glabus M. F. , Muir W. J.
Published: August 2018

In large families with affective illness, identification of a biological variable is needed that reflects brain dysfunction at an earlier point than symptom development. Eye movement disorder, a possible vulnerability marker in schizophrenia, is less clearly associated with affective illness, although a subgroup of affective disorders shows smooth-pursuit eye movement disorder. The auditory P300 event-related potential may be a useful marker for risk to schizophrenia, but a role in bipolar illness is less certain. The distribution of these two biological variables and their association with symptoms in two multiply affected bipolar families is described.

In a single, five-generation family identified for linkage studies through two bipolar I (BPI) probands, 128 members (including 20 spouses) were interviewed. The 108 related individuals had diagnoses of BPI (7), bipolar II (2), cyclothymia (3), or major depressive disorder (19). Eight others had generalised anxiety (1), minor depression (5), intermittent depression (1), or alcoholism (1). Sixty-nine subjects had no psychiatric diagnosis. P300 latency (81) and eye tracking (71) were recorded from a subgroup of relatives within the pedigree. Eye tracking was abnormal in 11 of 71 relatives (15.5%) and was bimodally distributed. In these 11 relatives, clinical diagnoses included minor depression (1), alcoholism (1) and generalised anxiety disorder (1). P300 latency was normally distributed and did not differ from controls. In a second family in which five of seven siblings have BPI illness, P300 latency and eye movement disorder were found in affected relatives and in some unaffected offspring. In these large families, clinical diagnoses of general anxiety, alcoholism and minor depression, when associated with eye tracking abnormality, may be considered alternative clinical manifestations of the same trait that in other relatives is expressed as bipolar illness.
Management of Treatment Resistant Schizophrenia Unresponsive to Clozapine
Authors: Barnes Thomas R. E. , McEvedy Christopher J. B. , Nelson Hazel E.
Published: August 2018

A recent challenge in schizophrenia has been the management of patients who have failed to respond not only to standard therapeutic regimes but also to trials of atypical neuroleptics such as clozapine and risperidone. This article focuses on the further psychological and pharmacological management of such patients.
Predictors of risk in serious sex offenders
Authors: Grubin Don
Published: August 2018

With the exception of a very few prolific offenders, sex offending is not a high rate activity. Even recidivist offenders will commit only a small number of offences in their careers, and these may be separated by intervals of years. Because of this, anyone setting out to predict reoffending by sex offenders will do best if they simply assume that none will reoffend, in which case they will be right more often than not. But such an approach, of course, would be criticised for being oversimplistic. Sex offenders have a history, and there is a common belief that if we know enough about an individual's past we should be able to predict his future with great accuracy. This has led some workers to claim that if the right variables can be discovered and plugged into a risk assessment algorithm, then the resulting desktop prediction of risk will outperform any competing clinical method.
Assessing dangerousness: protecting the interests of patients
Authors: Bingley William
Published: August 2018

Peter Scott's (1975) characterisation of the concept of dangerousness as potentially dangerous in itself could not be more relevant than today. The principal focus of mental health policy over the last six years has been the care and treatment of seriously mentally ill people and mentally disordered offenders, and central to the successful care of the former and many of the latter is the competent assessment of the risk they pose: mostly to themselves, but occasionally to others.
Risk assessment in a climate of litigation
Authors: Harrison Glynn
Published: August 2018

There has been a sea change in public attitudes toward the use of litigation in medicine over recent years. Mental health professionals are beginning to add an additional factor to their risk calculations when managing difficult patients: the assessment of risk (of a civil action) to themselves in the event of an untoward incident. This development must be recognised and anticipated if we are to assess fully the potential benefits, and the costs, of closer surveillance of vulnerable patients in the community.
Enantioselective Hydrogenation of Ketones over a Tartaric Acid-Modified Raney Nickel Catalyst: Substrate-Modifier Interaction Strength and Enantioselectivity
Authors: Choliq Azka Azkiya , Murakami Eitaro , Yamamoto Shota , Misaki Tomonori , Fujita Morifumi , Okamoto Yasuaki , Sugimura Takashi
Published: August 2018

Chiral (R,R)-tartaric acid and NaBr-doubly modified Raney nickel (TA-MRNi) is a promising heterogeneous catalyst for enantioselective hydrogenation of prochiral β-keto esters. To obtain deeper insights into the factors ruling the enantioselectivity, enantiodifferentiating hydrogenation of substituted ketones was studied over TA-MRNi and NaBr-modified RNi by use of combined individual-competitive hydrogenation techniques. Relative equilibrium adsorption constants of the substrates were estimated to evaluate their relative interaction strength with adsorbed tartaric acid moiety. DFT calculations were also performed to estimate the interaction energy through hydrogen bonding, providing clear support to the kinetic analysis and surface model. It is concluded with the enantioselective hydrogenation of ketones over TA-MRNi that the enantioselectivity increases as the substrate-modifier interaction strength increases: methyl acetoacetate (MAA) > acetylacetone (AA) ≈ 4-hydroxy-2-butanone (HB) > 2-octanone (2O).
Synthesis and Characterization of Dendritic Pt Nanoparticles by Using Cationic Surfactant
Authors: Kani Kenya , Zakaria Mohamed B , Lin Jianjian , Alshehri Abdulmohsen Ali , Kim Jeonghun , Bando Yoshio , You Jungmok , Hossain Md Shahriar A , Bo Jiang , Yamauchi Yusuke
Published: August 2018

Platinum (Pt) is known as one of the most promising electrocatalysts, and nanostructured Pt materials have enhanced its activity due to their abundant catalytically active sites derived from their high surface area. Herein, we synthesize fascinating dendritic Pt nanoparticles (DPNs) by a soft-templating method using hexadecyltrimethylammonium chloride (CTAC) as a pore-forming agent. The dissolved negatively charged Pt precursor (PtCl42−) effectively interact with the surfactant. The particle size of the obtained DPNs is around 20 nm, and the pore walls are composed of Pt nanocrystals. The obtained DPNs show good electrocatalytic activity towards methanol oxidation reaction (MOR) compared to commercial Pt black (PtB), and its stability is also higher than that of PtB.
Evaluating the associations of race, ethnicity, and food allergens in the development of childhood asthma: Re-analysis of publicly available retrospective cross-sectional cohort data
Authors: Abdalhuk Musheer , Jordan Angel , Wagimin Roghan , Stamitoles Charles , Bellinger Shandra , Baguley Joshua , Srour Hayat , Fomennko Ruslan , Sutton Jennifer , Santana Melany , Marull Armando , Rivera-Mariani Félix E.
Published: August 2018

Asthma is among the most prevalent chronic diseases affecting children worldwide. Sociodemographic factors, such as race and ethnicity, as well as food allergens and their association with asthma, have been extensively studied in an individual manner. Less is known about how food allergens can influence the effect of sociodemographic factors on childhood asthma prevalence. In this study, we re-analyzed a publicly available retrospective cross-sectional cohort dataset of childhood asthma. Multiple logistic regression of asthma by race and ethnicity, before and after adjustment by the most prevalent allergens, was implemented to the dataset. Hispanic individuals showed a higher odds risk (ORs; 1.30, CI 1.26 – 1.35) of asthma than Non-Hispanic individuals (0.24, CI 0.23 – 0.25), but after adjustment by most frequent food allergens reactivities (shellfish, peanut, and milk), the asthma odd risks were comparable (Hispanic, 3.62 [CI 3.49 – 3.76]; Non-Hispanic, 3.51 [3.47 – 3.52]). When considering race, Black individuals (1.90, CI 1.87 – 1.94) had higher ORs of asthma than White individuals (0.21, CI 0.20 – 0.22), Asian/Pacific Islander individuals (1.00, CI 0.95 – 1.05), and Other/Unknown races (1.14, CI 1.11 – 1.27). Although the ORs increased by three to four times for all races after adjusting for the most frequent food allergen reactivities, the same pattern of childhood asthma remained when considering races (in this order, Black, Other/Unknown, Asian/Pacific Islander, and White). In the dataset evaluated in this study, food allergens modified the association of race and ethnicity with the development of asthma. Therefore, public health interventions that gear towards the incidence of childhood asthma should contemplate the interplay and differences in nutrition among races and ethnicities.
Early life adiposity and telomere length across the life course: a systematic review and meta-analysis
Authors: Guyatt Anna L. , Rodriguez Santiago , Gaunt Tom R. , Fraser Abigail , Anderson Emma L.
Published: August 2018

Background: The relationship between adiposity at birth and in childhood, and telomere length is yet to be determined. We aimed to systematically review and meta-analyse the results of studies assessing associations between neonatal and later childhood adiposity, and telomere length.

Methods: We searched Medline, EMBASE and PubMed for studies reporting associations between adiposity measured in the neonatal period or later childhood/adolescence, and leucocyte telomere length, measured at any age via quantitative polymerase chain reaction, or terminal restriction fragment analysis, either cross-sectionally, or longitudinally. Papers published before April 2017 were included.

Results: Out of 230 abstracts assessed, 23 papers (32 estimates) were retained, from which 19 estimates were meta-analysed (15 cross-sectional, four longitudinal). Of the 15 cross-sectional estimates, seven reported on neonates: four used binary exposures of small-for-gestational-age vs. appropriate-for-gestational age (or appropriate- and large-for-gestational age), and three studied birth weight continuously. Eight estimates reported on later childhood or adolescent measures; five estimates were from studies of binary exposures (overweight/obese vs. non-obese children), and three studies used continuous measures of body mass index. All four longitudinal estimates were of neonatal adiposity, with two estimates for small-for-gestational-age vs. appropriate-for-gestational age neonates, and two estimates of birth weight studied continuously, in relation to adult telomere (49-61 years). There was no strong evidence of an association between neonatal or later childhood/adolescent adiposity, and telomere length. However, between study heterogeneity was high, and there were few combinable studies.

Conclusions: Our systematic review and meta-analysis found no strong evidence of an association between neonatal or later childhood or adolescent adiposity and telomere length.
Support surfaces for the treatment and prevention of pressure ulcers: a systematic literature review
Authors: Rae Katherine E. , Isbel Stephen , Upton Dominic
Published: August 2018

Objective:

Changes in technology have resulted in a lack of clarity regarding the comparative effectiveness between active and reactive support surfaces in the prevention and treatment of pressure ulcers (PUs). The purpose of this literature review was to evaluate the comparative effectiveness of active and reactive mattresses for prevention and treatment of PUs.

Method:

A literature search was completed using CINAHL, Medline Plus, Scopus, Cochrane Library and PubMed databases, as well as reference lists. A temporal limiter was placed excluding studies published before 2000 due to changes in care standards and support surface technology.

Results:

Of the 33 articles included, nine were systematic/literature reviews and 24 were randomised controlled trials (RCTs). There was a consensus that pressure mattresses are an effective prevention and treatment strategy, however comparisons of the two types were often inconclusive or conflicting. Studies were conducted in acute, sub-acute or residential facilities, with no studies in a domiciliary setting. The majority of studies were rated as moderate quality with significant methodological limitations.

Conclusion:

Further research is needed to investigate the use of support surfaces in a domiciliary setting with an appropriate methodology aimed at minimising the limitations described in the existing literature.
Evaluation of needs and treatment benefits in outpatient care for leg ulcer patients: a pilot study
Authors: Bobbink Paul , Morin Diane , Probst Sebastian
Published: August 2018

Objective:

Leg ulcers can take a long time to heal and have a high recurrence rate. This study aims to describe the sociodemographic and medical profile, and therapeutic needs of patients with leg ulcers, and the benefits of care in a specialised leg ulcers outpatient clinic.

Method:

This is a descriptive, cross-sectional pilot study of patients of a university hospital outpatient clinic. A sociodemographic and medical questionnaire and the Patient Benefit Index-wound (PBI-w) were used to collect data on the therapeutic needs (patient needs questionnaire, PNQ) and benefits of treatment (patient benefit questionnaire, PBQ) they received.

Results:

A total of 32 patients with leg ulcers were recruited. Results demonstrated that a clear diagnosis and therapy, rapid wound closure and confidence in the therapy given are the most important treatment objectives for patients. Patients mentioned that their therapy benefitted most from confidence in the treatment given, decreased pain and being able to continue living normally. The PBI-w mean score was 2.93 (standard deviation=0.75) on a scale of zero (‘did not help at all’) to four (‘helped a lot’). The PBI-w score showed that the patients benefitted from the treatment they received.

Conclusion:

This pilot study showed the feasibility of using the PBI-w in practice in an outpatient clinic to assess patients' needs, which could help health professionals improve treatment and care for people with leg ulcers. The study also pointed towards the benefits of care for patients who consult specialised outpatient clinics.
Relationship between skin temperature monitoring with Smart Socks and plantar pressure distribution: a pilot study
Authors: El-Nahas Mamdouh , El-Shazly Shaimaa , El-gamel Fayrouz , Motawea Mohamed , Kyrillos Fady , Idrees Hatem
Published: August 2018

Objective:

Increased skin temperature at the plantar aspect of the foot can predict foot ulceration. However its relation to plantar pressure overload is unknown. The aim of this study was to assess the ability of ‘smart socks’, monitoring plantar temperature under real-life conditions, to predict plantar pressure distribution.

Method:

The ‘smart socks’ have seven thermal sensors woven into the fabric of the sock to measure the temperature beneath the foot in real-life conditions. The upper part of the sock is connected to a central unit through which changes in the sensor resistance is converted into temperature changes. Participants were instructed to wear the socks for three continuous hours. Plantar pressure was measured by the MatScan plantar-pressure measurement system (Tekscan Inc., US).

Results:

The study included 25 healthy volunteers (11 males, 14 females, mean age was 41.1 years (standard deviation (SD): 17.6) years, a mean body mass index of 29.4 kg/m2 (SD: 6.95). Temperature changes at sensor (S) five significantly correlated with metatarsal (M) 2 pressure time integral (PTI) (r=0.519, p=0.008), M3 PTI (r=0.435, p=0.03), M4 PTI (r=0.452, p=0.023). Changes at S5 also significantly correlated with peak pressure at M2 (r=0.66, p=0.000), M3 (r=0.52, p=0.01), and M4 (r=0.60, p=0.002). Temperature changes at S6 were significantly correlated with changes at S1, S2, S3, S4, S5, and S7.

Conclusion:

Temperature changes at the plantar aspect of the foot measured by the smart socks are correlated with plantar pressure distribution. Furthermore, two sensors at positions S5 and S6 were sufficient to predict plantar pressure changes.
The Diccionario de Pedagogía by Labor, Barcelona (1936): the iconic-textual construction of a pedagogic discourse linked to the ideals of the “New School” / El Diccionario de Pedagogía de Labor, Barcelona (1936): la construcción icónico-textual de un discurso pedagógico ligado a los ideales de la Escuela Nueva/ (Bilingual Edition)
Authors: Costa Rico Antón , Amigo María Eugenia Bolaño
Published: August 2018

The important Editorial Labor of Barcelona, which had so much dissemination with its various bibliographic collections in Spain and in Latin America between 1920s to 1980s, was responsible for the editing of two notable Diccionarios de Pedagogía (Pedagogy Dictionaries), one in 1936 and another in 1964, both created from two different educational assumptions; in one case, from those belonging to the New School (1936) and the other from the so-called neo-scholastic and Catholic assumptions, as shown in the comparative contrast that is undertaken here. The contribution also takes care of the references to education in Brazil that are set out in the 1936 text.Keywords: Diccionario de Pedagogía Labor, New School, Pedagogic Discourse, Dictionaries, Sánchez Sarto ResumenLa importante Editorial Labor de Barcelona, que tanta difusión obtuvo con sus diversas colecciones bibliográficas en toda España y en Latinoamérica entre los pasados años veinte a ochenta del siglo XX, fue responsable de la edición de dos notables Diccionarios de Pedagogía, uno en 1936 y otro en 1964, elaborados ambos desde dos distintos supuestos educativos; en un caso, desde los propios de la Escuela Nueva (1936) y en el otro desde los supuestos neo-escolásticos y católicos, como se manifiesta en el contraste comparativo que aquí se realiza. La contribución se hace cargo, además, de las referencias a la educación en Brasil que se exponen en el texto de 1936.Palabras: Diccionario de Pedagogía Labor, Escuela Nueva, Discurso Pedagógico, Diccionarios, Sánchez Sarto.ResumoA importante Editora Labor de Barcelona, que obteve grande difusão em suas diversas coleções bibliográficas em toda Espanha e na América Latina entre as decadas de 1920 e 1980, foi respopnsável pela edição dos notaveis Diccionarios de Pedagogía, um em 1936 e outro em 1964, ambos elaborados a partir de distintos ideais educativos; de um lado, a partir da Escola Nova (1936) e, de outro, a partir das ideias neo-escolásticas e católicas, como se manifiesta no estudo comparativo que aqui é realizado. A contribuição também aborda as referências à educação no Brasil que estão expostas no texto de 1936.Palabras claves: Diccionario de Pedagogía Labor, Escola Nova, Discurso Pedagógico, Diccionarios, Sánchez Sarto.