bluuebunny/crossref_metadata_2025 huggingface dataset:
Skin Reactions Due to Antiepileptic Drugs: Several Case-Reports with Long-Term Follow-up
Authors: Feliciani C. , Verrotti A. , Coscione G. , Toto P. , Morelli F. , Di Benedetto A. , Salladini C. , Chiarelli F. , Tulli A.
Published: January 2017

In this study, the clinical findings and management of allergic skin reactions induced by the most used antiepileptic drugs, Lamotrigine (LMT) and Carbamazepine (CBZ), were evaluated. Lamotrigine is an antiepileptic drug recently released in several countries; it is effective for a variety of seizure types in adults and children, both as an add-on agent and in monotherapy, and it is generally well tolerated. Clinical and epidemiologic evidence suggest serious cutaneous reactions to antiepileptic drugs are more likely to occur during the first 8 weeks and they appear to increase when drugs are administered with other anticonvulsants, such as valproate (VPA). We selected 10 patients who presented an idiosyncratic skin rash when treated with carbamazepine (8 patients) and lamotrigine (2 patients) administered as monotherapy, and we followed up on these patients for several years. Seven reactions were mild/severe cutaneous eruptions; one Toxic Epidermal Necrolysis, a case of Stevens-Johnson and a case of Hypersensitivity Syndrome. All severe skin drug reactions were induced by Carbamazepine.

In five patients the AEDs were ceased abruptly (sometimes with the administration of a different molecule), tapered in four and continued unchanged in one. We conclude that the discontinuation of the drug with substitution with another is the most effective treatment and that corticosteroids are helpful in mild cutaneous reactions, while in severe skin reactions, such as Toxic Epidermal Necrolysis, corticosteroids are only a complementary therapy since intravenous immunoglobulins are the first choice treatment.
Cellular and Humoral Systemic and Mucosal Immune Responses Stimulated by an Oral Polybacterial Immunomodulator in Patients with Chronic Urinary Tract Infections
Authors: Marinova S. , Nenkov P. , Markova R. , Nikolaeva S. , Kostadinova R. , Mitov I. , Vretenarska M.
Published: January 2017

An oral polybacterial immunomodulator Urostim (U), composed of killed cells and their lysates from E. coli expressing type 1 and P-pili, E. coli Re mutant, P. mirabilis, K. pneumoniae and E. faecalis was created for immunoprophylaxis and immunotherapy of urinary tract infections (UTIs). In experimental animal models, the stimulating effect of U on lymphocyte functional activity, macrophage phagocytosis and antibody producing cells, was established. In this study the immuno-modulating effects of U on the proliferating capacity and ultrastructural morphologic changes of lymphocytes, cytokine production and specific systemic humoral and mucosal immune responses in patients with UTIs have been evaluated. Patients enrolled in the study, received orally 50 mg U daily for a period of three months. On days 0,30 and 90 a quantitative analysis was performed on lymphoproliferative responses to polyclonal mitogens, IL-2 and the specific antigen U, the production of specific serum and saliva IgA, IgM and IgG antibodies to all components of U and the concentration of pro-inflammatory cytokines. There was significant improvement of non-specific and specific lymphoproliferative responses on days 30 and 90 after the onset of treatment with U, confirmed by electron-microscopic studies. The highest concentrations of serum proinflammatory cytokines TNF-α, IL-1β, and IL-6 were registered at baseline followed by a decrease until the end of the observation period. This finding correlates with the gradual decrease of immune activation as measured by the spontaneous lymphocyte proliferation. Data from the production of specific antibacterial antibodies in serum and saliva show two types of reactions. The first type was registered in patients with low pre-treatment levels in whom the concentration of specific antibodies increased on days 30 and 90. The second type of reaction was observed in patients with high pre-treatment levels, which dropped on day 30 and were usually followed by an increase at the end of the study. These results provide evidence for the immuno-modulating effect of U. Our data show that the oral administration of the polybacterial immunomodulator Urostim stimulates adequate cellular and humoral systemic and mucosal immune responses in patients with chronic UTIs.
Neutrophil Recruitment in the Reperfused-Injured Rat Liver was Effectively Attenuated by Repertaxin, a Novel Allosteric Noncompetitive Inhibitor of Cxcl8 Receptors: A Therapeutic Approach for the Treatment of Post-Ischemic Hepatic Syndromes
Authors: Cavaliert B. , Mosca M. , Ramadori P. , Perrelli M.-G. , De Simone L. , Colotta F. , Bertini R. , Poli G. , Cutrin J. C.
Published: January 2017

Hepatic reperfusion injury represents a crucial problem in several clinical situations including liver transplantation, extensive hepatectomy and hypovolemic shock with resuscitation. Repertaxin is a new non-competive allosteric blocker of interleukin-8 (CXCL8) receptors, which by locking CXCR1/R2 in an inactive conformation, prevents receptor signaling and polymorphonuclear leukocyte (PMN) Chemotaxis. The present study shows that repertaxin dramatically prevents rat post-ischemic hepatocellular necrosis (80% of inhibition) and PMN infiltration (96% of inhibition) at a clinically-relevant time (24 h) of reperfusion. Treatment with repertaxin by continuous infusion is demonstrated to be the optimal route of administration of the compound especially in view of its clinical threrapeutic use. Because repertaxin has proven to be safe and well tolerated in different animal studies and in phase I studies in human volunteers, it is in fact a candidate novel therapeutic agent for the prevention and treatment of hepatic post-ischemic injury.
Genetic Variability among Blastoschizomyces Capitatus Isolates from Different Clinical Sources
Authors: Pontieri E. , Caracciolo C. , Ceddia T. , Oliva B. , Ferrini A. , Girmenia C. , D'Antonio D.
Published: January 2017

Sixteen clinical isolates and nine ATCC reference strains of Blastoschizomyces capitatus were analysed genetically, examined for the cellobiose, arbutin and salicin assimilation and tested for the aspartyl-proteinase secretion. The restriction endonuclease analysis (REA) with HpaII and HinfI enzymes and the electrophoretic karyotype (EK) were investigated. Both the restriction enzymes revealed two groups (I, II) constituted by the same isolates: 17 isolates (68%) in group I and 8 (32%) in group II. The EK analysis revealed sixteen groups. These data prompts for a genetic variability of the isolates of Blastoschizomyces capitatus and their account in two distinct genetic groups as suggested by REA. This grouping was confirmed by examing the utilisation of cellobiose, arbutin and salicin. The tests for secretory aspartyl proteinase (Sap) were positive only for three isolates, suggesting a marginal role of this specific enzyme in pathogenesis for these isolates.
Community Acquired Pneumonia in Internal Medicine: A One-Year Retrospective Study Based on Pneumonia Severity Index
Authors: Riccioni G. , Dipietro V. , Staniscia T. , De Feudis L. , Traisci G. , Capani F. , Ferrara G. , Di Ilio E. , Di Tano G. , D'Orazio N.
Published: January 2017

Community acquired pneumonia (CAP) represents the sixth cause of death and the first cause of death for an infectious disease in the USA. The aim of the present study is to evaluate how CAP is managed in a hospital setting, with particular attention to the wards of internal medicine, compared to the recommendations based and validated PSI (Pneumonia Severity Index). 42 subjects were included in the study, 25 males and 17 females. According to the PSI, nine (21%) patients were classified in class I, two (5%) in class II, ten (24%) in class III, fifteen (36%) in class IV and six (14%) in class V. Three patients died during the stay in the hospital (2 males and 1 female), all in the highest PSI class (V). According to the criteria used to evaluate the adequacy of the admission to the hospital, twentyeight patients were classified in the HRG, with an appropriate admission, whilst fourteen (33%) were in the LRG, with an inappropriate admission to the hospital. The data of the study confirm the validity of a PSI based strategy for the management of CAP since admittance to the hospital. This approach is not yet widely implemented in Italy, and a better dialogue between hospital and health system representatives would be convenient, to reduce costs and ensure the safety of patients affected by CAP.
N-Oleoyl-Dopamine Increases Locomotor Activity in the Rat
Authors: Przegaliński E. , Filip M. , ZająC D. , Pokorski M.
Published: January 2017

N-oleoyl-dopamine (OLDA), a condensation product of oleic acid and dopamine (DA), is a bioactive lipid whose biological functions are not yet fully explored. The compound crosses the blood-brain barrier and might be considered as a carrier of DA into the brain. In this study we sought to determine whether OLDA would influence locomotor behavior and whether the central DA system would be involved in such influence. We addressed this issue by investigating horizontal locomotor activity in male Wistar rats after intraperitoneal administration of OLDA, 5–20 mg/kg, before and after pre-treatment with haloperidol, a D2 receptor antagonist. We found that OLDA caused a prompt stimulation of locomotor activity, with a bell-shaped dose-response. The maximum stimulatory effect was observed after 10 mg/kg of OLDA where the mean distance traveled by rats during a 2-hour test increased to 1213 ±196(SE) cm from the 403 ±89 cm in the vehicle-treated rats (p<0.05). This effect was dose-dependently antagonized by haloperidol (0.1–0.2 mg/kg). The results support the hypothesis that the OLDA-induced hyperlocomotion was mediated by the stimulation of DA systems. Using in vitro assays, we further demonstrated that OLDA is a stable compound that resists hydrolysis over a 2-hour period and thus the integral OLDA compound exerted DA-like effects. We conclude that OLDA is a potential brain modifier of motor behavior, the biological consequences of which remain to be explored.
Occupational Allergic Contact Dermatitis from Mioga (Zingiber Mioga Rosc.) in Greenhouse Cultivators
Authors: Minamoto K. , Harada K. , Wei Q.J. , Wei C.N. , Omori S. , Ueda A.
Published: January 2017

Mioga ( Zingiber mioga Rosc.) is a member of the ginger family (Zingiberaceae), which is native to tropical Asia. In Japan, the young flower buds are used as a spice, and hand dermatitis suspected as being an allergy to mioga has been recognized in mioga greenhouse cultivators. To investigate the extent of the problems and the causes of dermatitis, 20 householders cultivating mioga in their greenhouses were asked to participate in a questionnaire study. Consecutive patch tests were performed on some subjects with dermatitis. Self-reported questionnaires were distributed to the main cultivator in each household who attended a lecture of mioga cultivation methods held at an agriculture cooperative association in the area. Some subjects who answered as presenting or having had hand dermatitis were patch tested for mioga (as is), four kinds of mioga extracts, and three kinds of natural rubber gloves. Results: 35 cultivators from 16 households answered the questionnaire. Eight of the 35 subjects (22.9%) answered that they had experienced hand dermatitis since they started mioga cultivation. Four of the 8 subjects were patch tested. Two of the 4 subjects showed allergic reactions to mioga (as is) and the extracts. The other two cases showed irritation to mioga (as is). The first two cases also showed allergic reactions to natural rubber gloves. To our knowledge, there is no previous report of allergic contact dermatitis from mioga.
Treatment of Psoriasis with Different Dosage Regimens of Etanercept: Preliminary Results from the TαRanta Plastic Study Group
Authors: Cassano N. , Loconsole F. , Miracapillo A. , Travaglini M. , Digiuseppe M.D. , Congedo M. , Galluccio A. , Buquicchio R. , Mastrandrea V. , Filieri M. , Raho G. , Pezza M. , Vena G.A.
Published: January 2017

This pilot open-label study is aimed to assess clinical response in psoriasis patients receiving diverse dose regimens of etanercept, consisting of the same global cumulative dose of etanercept administered over different treatment periods. Eligible patients were assigned sequentially in a 1:1 ratio to receive: etanercept 50 mg once weekly (QW) or 50 mg twice weekly (BIW) for 12 weeks. The final analysis included a total of 72 patients. At week 12 the Psoriasis Area and Severity Index (PASI) and Skindex-29 scores notably improved in both treatment arms, without significant differences between the two groups. The rate of patients attaining a PASI improvement ≥ 50% (PASI 50) at week 12 was 92% in the high-dose group. In these patients, etanercept dosage was decreased to 50 mg QW from week 13, with persistence of the PASI 50 response at week 24 in all cases. Thereafter, treatment was discontinued up to week 36 and almost 30% of patients experienced a gradual relapse of their psoriasis within this period. In the low-dose group, the PASI 50 response was observed in 75% of patients. These responders continued to be treated with etanercept 50 mg QW up to week 36 with persistence of the PASI 50 in 100% of cases at week 24 and 93% at week 36. In the low-dose regimen, 8 patients who did not respond at week 12 underwent dose escalation to 50 mg BIW for a further 12 weeks. At week 24, six of these patients gained the PASI 50 response, 4 of whom maintained the response up to week 36, after treatment discontinuation from week 24. Our results confirm that etanercept is very effective and well-tolerated in psoriasis and that the drug dosages and treatment duration may be modulated and adapted to clinical needs in a flexible way.
Reductive Alteration of the Regulatory Function of the CD4+CD25+ T Cell Fraction in Silicosis Patients
Authors: Hayashi H. , Miura Y , Maeda M. , Murakami S. , Kumagai N. , Nishimura Y. , Kusaka M. , Urakami K. , Fujimoto W. , Otsuki T.
Published: January 2017

Causal links have been documented between silica and rheumatoid arthritis, lupus erythematosus, systemic sclerosis and glomerulonephritis. Two different effects of silica have been suggested, an enhanced inflammatory response in the pulmonary region (e.g. activation of alveolar macrophages) and dysregulation of autoimmunity. Based on our previous reports showing in vitro activation of peripheral T cells by silica and reduced regulatory function of the peripheral CD4+CD25+ fraction in which FoxP3+ regulatory T cells (Treg) are located, reconstitution of the CD4+CD25+ fraction in silicosis patients (SILs) was investigated. Since T cells in peripheral CD4+CD25+ and CD4+CD25− (effector T cells; Teff) fractions from SILs showed higher expression of pd-1 (a marker gene for T cell activation) in comparison to that of healthy donors (HDs), chronic T cell activation was considered to have occurred in SILs. In this study, a higher expression of the CD95/Fas molecule in Treg was recorded from silicosis patients (SILs) compared to healthy donors (HDs), and excess loss of FoxP3+ Treg in freshly isolated peripheral blood mononuclear cells (PBMCs) from SILs relative to HDs was demonstrated when these cells were cultured with silica ex vivo, whereas CD25+ cells were not reduced due to contamination of activated Teff in the CD4+CD25+ fraction. The activation of both Teff and Treg results in reconstitution of the peripheral CD4+ CD25+ fraction, loss of Treg and contamination of activated Teff, resulting in reduction of the number and function of Treg. These results contribute to our understanding of the development of autoimmune diseases found in SILs.
Novel Perspectives in the Detection of Oral and Nasal Oxidative Stress and Inflammation in Pediatric United Airway Diseases
Authors: Profita M. , Montuschi P. , Bonanno A. , Riccobono L. , Montalbano A.M. , Ciabattoni G. , Albano G.D. , Liotta G. , Bousquet J. , Gjomarkaj M. , La Grutta S.
Published: January 2017

United airway disease (UAD) concept proposed that asthma and rhinitis are both different clinical manifestation of a single inflammatory process. The aim of this study is to assess in upper and lower airways the level of inflammation and oxidative stress and to investigate the relationship between biomarkers in persistent allergic rhinitis (PER) and in concomitant asthma with PER. By a cross-sectional study we measured oral and nasal (FENO) and oral and nasal EBC 8-isoprostane, LTB4 and PGE in children with PER (n=14) and with PER and concomitant intermittent asthma (IA; n=25), mild persistent asthma (mA; n=28), moderate persistent asthma (MA; n=13) and in Healthy Controls (HCs; n=13). Oral and nasal FENO concentrations were increased in children with PER, IA, mA and MA when compared with HCs. Nasal 8-isoprostane was higher in EBC of children with PER and asthma than in HCs. Oral and nasal LTB4 were higher in EBC of children with PER and mA than in HCs. Oral and nasal PGE2 concentrations were higher in EBC of children with PER than in HCs. Positive correlations between oral and nasal biomarkers were found in IA for LTB4 and PGE2, in mA for FENO, 8-isoprostane, LTB and PGE2, and in MA for PGE2. No correlations were observed in children with PER and HCs. Our results suggest that non-invasive markers of inflammation and oxidative stress might be useful to study the relationships between oral and nasal compartments in allergic children with PER and concomitant asthma with the aim of defining the UAD.
Celiac Disease, Primary Biliary Cirrhosis and Helicobacter Pylori Infection: One Link for Three Diseases
Authors: Abenavoli L. , Arena V. , Giancotti F. , Vecchio F.M. , Abenavoli S.
Published: January 2017

The association between celiac disease (CD) and primary biliary cirrhosis (PBC) has been reported in literature. Recent epidemiological studies showed an increased prevalence of CD in patients with PBC and vice versa. The cause of PBC is unknown. However, considerable evidence points to an autoimmune basis. The role of infectious agents, such as Helicobacter pylori (H. pylori), has been proposed to stimulate antibody cross-reaction with mitochondria of the bile duct cells. We report a case of a 36-year-old woman with diagnosis of CD, PBC and H. pylori infection. Strict adherence to gluten-free diet, associated to ursodeoxycholic acid (UDCA) administration and eradication treatment for H. pylori infection, led to a marked improvement of clinical status. Our experience supports the pathogenetic role of increased intestinal permeability in the course of CD and H. pylori infection to induce PBC. Future studies are needed to clarify this link to, and in particular the role played by abnormal intestinal permeability and infectious agents in the pathogenesis of PBC.
Can Immune Disorders Influence Therapeutical Approach in Treatment of Epilepsy among Neurologists? A First Co-Operative National Recognition in Italy
Authors: Francia A. , Luzi G. , Morreale M. , Vanacore N. ,   The Italian Epilepsy and Immunity Relationship Study Group
Published: January 2017

Functional disturbances of the immune system have been detected more often among persons affected by epilepsy than in the general population. In the February-July period of 2007 a specific questionnaire on the relationship between epilepsy and immunological response was sent to 27 specialized Centres for Epilepsy in nine Italian regions. 15,388 epileptic patients attended twenty-seven Centers during this six-month period. 3.3% (n=502) of these patients suffered an immune disease. This is the first national survey on the relationship between epilepsy and immunological response in current clinical practice.
The Duty to Warn and Protect—Impact on Practice
Authors: Chaimowitz Gary A , Glancy Graham D , Blackburn Janice
Published: January 2017

Objective:

To discuss the concepts of the duty to protect and the associated threat to confidentiality and their impact on practice for Canadian psychiatrists.

Method:

We review these concepts and provide a synthesis of legal cases impacting psychiatric practice.

Conclusion:

The onus is on the psychiatrist to make him or herself aware of the current state of the legal obligation with respect to duty to protect. The evolving concept of duty to protect has and will continue to have significant impact on the practice of psychiatry.
“Diet Pills” and Major Depression in the Canadian Population
Authors: Patten Scott B
Published: January 2017

Objective:

To evaluate epidemiological associations between self-reported diet pill consumption and major depressive episodes (MDEs), using data from a large-scale, cross-sectional survey of the Canadian population.

Methods:

Data from the National Population Health Survey (NPHS) were used in this analysis. The NPHS interview included a brief version of the Composite International Diagnostic Interview (CIDI) depression section, known as the CIDI Short Form for Major Depression (CIDI-SFMD), as well as provision for self-reported medication use.

Results:

Approximately 0.5% of the population reported the use of diet pills. Diet pill use was more common among women than among men. At the time of data collection (1996–1997), the most commonly used medication was fenfluramine (since withdrawn from the market because of cardiovascular toxicity). The use of these medications was strongly associated with MDE: the annual prevalence among persons reporting use was 17.1% (95%CI, 8.6 to 25.6), approximately 4 times the underlying population rate.

Conclusions:

Because the NPHS was a general health survey, and because self-reported exposure to these medications was relatively uncommon, the data did not permit a detailed multivariate analysis. These findings, however, indicate that depressive psychopathology is strongly associated with the use of appetite-suppressant medications.
In vivo Magnetic Resonance Spectroscopy and its Application to Neuropsychiatric Disorders
Authors: Stanley Jeffrey A
Published: January 2017

In vivo magnetic resonance spectroscopy (MRS) is the only noninvasive imaging technique that can directly assess the living biochemistry in localized brain regions. In the past decade, spectroscopy studies have shown biochemical alterations in various neuropsychiatric disorders. These first-generation studies have, in most cases, been exploratory but have provided insightful biochemical information that has furthered our understanding of different brain disorders. This review provides a brief description of spectroscopy, followed by a literature review of key spectroscopy findings in schizophrenia, affective disorders, and autism.

In schizophrenia, phosphorus spectroscopy studies have shown altered metabolism of membrane phospholipids (MPL) during the early course of the illness, which is consistent with a neurodevelopmental abnormality around the critical period of adolescence when the illness typically begins. Children and adolescents who are at increased genetic risk for schizophrenia show similar MPL alterations, suggesting that schizophrenia subjects with a genetic predisposition may have a premorbid neurodevelopmental abnormality.

Independent of medication status, bipolar subjects in the depressive state tended to have higher MPL precursor levels and a deficit of high-energy phosphate metabolites, which also is consistent with major depression, though these results varied. Further bipolar studies are needed to investigate alterations at the early stage.

Lastly, associations between prefrontal metabolism of high-energy phosphate and MPL and neuropsychological performance and reduced N-acetylaspartate in the temporal and cerebellum regions have been reported in individuals with autism. These findings are consistent with developmental alterations in the temporal lobe and in the cerebellum of persons with autism. This paper discusses recent findings of new functions of N-acetylaspartate.
The Impact of Latitude on the Prevalence of Seasonal Depression
Authors: Levitt Anthony J , Boyle Michael H
Published: January 2017

Background:

This study sought to determine whether the prevalence of the seasonal subtype of major depression (SAD) in the community varied as a function of latitude.

Methods:

Random telephone numbers were generated across 8 degrees of latitude (41.5 °N to 49.5°N) for the province of Ontario. Eight strata of 1 degree each were sampled equally throughout a 12-month period. Using a validated and structured diagnostic interview, we interviewed by telephone respondents over 20 years of age who had lived in the region for 3 years or more. We evaluated patterns of symptom change across seasons to establish a diagnosis of SAD according to DSM-IV criteria.

Results:

Of the 2078 households that were assessed for eligibility, 1605 (77%) completed the interview. The crude prevalence of lifetime SAD was 2.6% (95% CI, 1.9 to 3.5). There was no impact of latitude on prevalence of either major depression or the seasonal subtype across the 8 strata, although the global measure of the severity of seasonal change in mood was significantly negatively correlated with latitude.

Conclusions:

SAD is a common subtype of major depression in Ontario, but there is no evidence to support an increase in prevalence with increasing latitude.

Contexte:

Cette étude visait à déterminer si la prévalence du caractère saisonnier de la dépression majeure (DMS) dans la communauté variait selon la latitude.

Méthodes:

Des numéros de téléphone aléatoires ont été fournis sur 8 degrés de latitude (de 41,5°N. à 49,5°N.) dans la province de l'Ontario. Huit bandes de 1 degré chacune ont été échantillonnées également sur une période de 12 mois. À l'aide d'une entrevue diagnostique validée et structurée, nous avons interviewé par téléphone des répondants âgés de plus de 20 ans qui habitaient la région depuis 3 ans ou plus. Nous avons évalué les changements des modèles de symptômes selon les saisons pour établir un diagnostic de DMS selon les critères du DSM-IV.

Résultats:

Sur les 2 078 ménages admissibles, 1 605 (77 %) ont terminé l'entrevue. La prévalence brute de la DMS à vie était de 2,6 % (95 % IC, 1,9 à 3,5). La latitude n'influait pas sur la prévalence de la dépression majeure ou du caractère saisonnier dans les 8 bandes, bien que la mesure globale de la sévérité du changement saisonnier de l'humeur ait indiqué une corrélation négative significative à la latitude.

Conclusions:

La dépression majeure saisonnière est un sous-type répandu de la dépression majeure en Ontario, mais aucune preuve ne soutient une augmentation de la prévalence parallèle à l'accroissement de la latitude.
Randomization in a Substance Abuse Treatment Study: Participants Who Consent vs Those Who Do Not
Authors: Seraganian Peter , Brown Thomas G , Tremblay Jacques
Published: January 2017

Objective:

A mixed research design study compared patients who consented to treatment randomization with patients who opted for usual care.

Methods:

Patients in substance abuse rehabilitation who consented to randomization (that is, consenting group [CG]) were compared with those unwilling to undergo randomization (that is, nonconsenting group [NG]) but who, nevertheless, underwent the experimental assessment sessions, which spanned from intake to 6-month follow-up.

Results:

Patients in the CG exhibited a longer history of drug abuse, less occupational stability at intake, and following intensive treatment, tended not to do as well in terms of recovery, compared with those in the NG.

Conclusion:

Inclusion of data from partial participants in research protocols may offer a viable strategy to better appraise data generalizability.
Implementing Quality Management in Psychiatry: From Theory to Practice—Shifting Focus from Process to Outcome
Authors: McGrath Brent M , Tempier Raymond P
Published: January 2017

With the increasing emphasis on the satisfaction of patient-clients balanced by the need for cost-efficient treatment, quality management is an ever-increasing concern for mental health care providers. It is now apparent that psychiatrists must follow treatment progress and outcome to assess and improve the quality of the care they provide. Most quality measurement and management programs to date have been carried out in research settings using process measures; however, it is clear that the focus must shift from research to practice and from process to outcome measurements. We discuss the notion of quality and outcome management and propose a model for selecting outcome measures. This model suggests 5 dimensions that are commonly assessed in outcome management. We successfully implemented a computerized documentation and quality measurement system in a psychiatric outpatient setting.
Patient Attitudes regarding Causes of Depression: Implications for Psychoeducation
Authors: Srinivasan Janaki , Cohen Nicole L , Parikh Sagar V
Published: January 2017

Objective:

Patient attitudes toward mental illness are an important determinant of treatment compliance and treatment outcome. A patient's age, sex, style of thinking, lifestyle, and beliefs all may influence perceptions. This study aimed to determine patient attitudes.

Method:

Patients with a depressive disorder ( n = 102) who were referred for psychiatric consultation and treatment to a community general hospital psychiatric outpatient clinic completed a 9-item self-report questionnaire to determine their perceptions of the biological, psychological, cognitive, and spiritual causes of their depressive disorder.

Results:

Women were more likely to endorse their depressive disorder as related to a biological abnormality. With respect to age, older individuals were less likely to identify cognitive factors and loss of spirituality as causal factors in their depression.

Conclusions:

A relation exists between demographic variables, including sex and age, and beliefs about causes of depression and related disorders. These findings have implications for refining patient psychoeducation.
Subtypes of Schizophrenia: A Cluster Analytic Approach
Authors: Helmes Edward , Landmark Jhan
Published: January 2017

Objectives:

To identify empirical subtypes of schizophrenia, based upon the symptoms recorded over the duration of the illness, and to validate the resulting clusters against other systems that are used for subtyping schizophrenia.

Method:

Data for 55 symptoms of schizophrenia over the history of the illness from 107 chronic schizophrenia patients were analyzed using hierarchical cluster analysis with Euclidean distance and Ward's method. Except for 1 patient, all met DSM-III criteria. There were 40 men and 67 women, average (SD) age of 38.2 (9.91) years, with amean (SD) hospitalization of 27.9 (27.35) months.

Results:

No clear and unambiguous solution for the number of clusters was evident. Examination of the clusters led to further analysis of 2- and 6-cluster solutions. These were contrasted with DSM-III, DSM-III-R, and DSM-IV criteria and with the subtypes taken from the literature. There was limited support for any of these types, with none replicating, including the paranoid–nonparanoid distinction.

Conclusions:

Empirical clusters derived from lifetime symptom data failed to agree with either the established DSM or other empirically derived subtypes. Subtypes may have little utility when the variability of symptoms over the longitudinal course of the illness is considered.
Intramuscular Olanzapine and Intramuscular Haloperidol in Acute Schizophrenia: Antipsychotic Efficacy and Extrapyramidal Safety during the First 24 Hours of Treatment
Authors: Wright Padraig , Lindborg Stacy R , Birkett Martin , Meehan Karena , Jones Barry , Alaka Karla , Ferchland-Howe Iris , Pickard Anne , Taylor Cindy C , Roth John , Battaglia John , Bitter István , Chouinard Guy , Morris Philip LP , Breier Alan
Published: January 2017

Objective:

To determine the antipsychotic efficacy and extrapyramidal safety of intramuscular (IM) olanzapine and IM haloperidol during the first 24 hours of treatment of acute schizophrenia.

Method:

Patients ( n = 311) with acute schizophrenia were randomly allocated (2:2:1) to receive IM olanzapine (10.0 mg, n = 131), IM haloperidol (7.5 mg, n = 126), or IM placebo ( n = 54).

Results:

After the first injection, IM olanzapine was comparable to IM haloperidol and superior to IM placebo for reducing mean change scores from baseline on the Brief Psychiatric Rating Scale (BRPS) Positive at 2 hours (–2.9 olanzapine, −2.7 haloperidol, and −1.5 placebo) and 24 hours (–2.8 olanzapine, −3.2 haloperidol, and −1.3 placebo); the BPRS Total at 2 hours (–14.2 olanzapine, −13.1 haloperidol, and −7.1 placebo) and 24 hours (–12.8 olanzapine, −12.9 haloperidol, and −6.2 placebo); and the Clinical Global Impressions (CGI) scale at 24 hours (–0.5 olanzapine, −0.5 haloperidol, and −0.1 placebo). Patients treated with IM olanzapine had significantly fewer incidences of treatment-emergent parkinsonism (4.3% olanzapine vs 13.3% haloperidol, P = 0.036), but not akathisia (1.1% olanzapine vs 6.5% haloperidol, P = 0.065), than did patients treated with IM haloperidol; they also required significantly less anticholinergic treatment (4.6% olanzapine vs 20.6% haloperidol, P < 0.001). Mean extrapyramidal symptoms (EPS) safety scores improved significantly from baseline during IM olanzapine treatment, compared with a general worsening during IM haloperidol treatment (Simpson–Angus Scale total score mean change: −0.61 olanzapine vs 0.70 haloperidol; P < 0.001; Barnes Akathisia Scale global score mean change:−0.27 olanzapine vs 0.01 haloperidol; P < 0.05).

Conclusion:

IM olanzapine was comparable to IM haloperidol for reducing the symptoms of acute schizophrenia during the first 24 hours of treatment, the efficacy of both being evident within 2 hours after the first injection. In general, more EPS were observed during treatment with IM haloperidol than with IM olanzapine.
Impact of Antidepressant Side Effects on Adolescent Quality of Life
Authors: Cheung Amy H , Levitt Anthony J , Szalai John P
Published: January 2017

Objective:

This study examines the relative impact of antidepressant side effects on adolescents with a history of major depression.

Methods:

We used Q-sort methodology to capture the opinions of adolescents with a history of depression ( n = 22), adults with a history of depression ( n = 20), healthy adolescents ( n = 20), and clinicians ( n = 18) on the impact of 40 common antidepressant side effects. We asked subjects to force rank the side effects, judging each side effect on its relative impact on their daily lives. We also examined the impact of these side effects on health status and medication compliance. Primary analyses compared adolescents with depression with the other groups on their mean rankings for each of the 40 side effects. Secondary analyses included paired comparisons for ratings on health status and compliance.

Results:

Although all groups ranked syncope and vomiting among the worst 5 side effects, significant differences were found between the groups on other side effects, such as anxiety, sleepiness, and hair loss. Based on the side effect with the most negative impact, adolescents with depression judged their own compliance (mean = 22%) to be higher than predicted by clinicians (mean = 11%). There were no significant differences between the groups on the mean rating of health status.

Conclusions:

Adolescents with depression, adults with depression, healthy adolescents, and clinicians agreed on the negative impact of 2 side effects: vomiting and syncope. Q-sort methodology provides valuable insight into the similarities and differences in opinion regarding the potential impact of side effects in patient groups.
Depressive Symptomatology in the Immediate Postnatal Period: Identifying Maternal Characteristics Related to True- and False-Positive Screening Scores
Authors: Dennis Cindy-Lee , Ross Lori E
Published: January 2017

Objective:

To determine whether true- and false-positive postnatal depression screening scores can be distinguished during the early postpartum period by examining characteristic differences between 2 groups: 1) women with depressive symptomatology at 1 week postpartum who continue to exhibit symptoms at 8 weeks postpartum, compared with those who do not; and 2) women with depressive symptomatology at 8 weeks postpartum who previously exhibited symptoms at 1 week postpartum, compared with those who did not.

Method:

As part of a longitudinal postpartum depression study, a population-based sample of 594 women completed mailed questionnaires at 1, 4, and 8 weeks postpartum.

Results:

Among women with depressive symptomatology at 1 week postpartum, diverse variables distinguished between those whose symptoms persisted or remitted at 8 weeks. These variables included recent immigrant status, psychiatric history, premenstrual symptoms, vulnerable personality, low self-esteem, child abuse history, and insufficient support. Variables that distinguished between women with depressive symptomatology at 8 weeks postpartum who previously exhibited symptoms at 1 week postpartum and those who did not included vulnerable personality, life stressors, perceived stress, insufficient support, and partner conflict.

Conclusions:

To address both the benefits and potential harms of early screening, positive screening scores on the Edinburgh Postnatal Depression Scale should also include an assessment of each individual woman's risk for postpartum depression and (or) chronic major depression.
Left-Handedness and Developmental Coordination Disorder
Authors: Cairney John , Schmidt Louis A , Veldhuizen Scott , Kurdyak Paul , Hay John , Faught Brent E
Published: January 2017

Objective:

To examine the prevalence of left-handedness in a sample of children screened for developmental coordination disorder (DCD).

Method:

Using the Bruininks-Oseretsky Test of Motor Proficiency—Short Form (BOTMP-SF), 2297 children were screened with 128 scoring at or below the fifth percentile and identified as probable cases of DCD. Using the Movement-ABC (M-ABC) and the Kaufman Brief Intelligence Test, 30 children (24 from the DCD group, and 6 who scored above the cut-off) were randomly selected for further assessment.

Results:

Among the students who had previously scored at or below the fifth percentile on the BOTMP-SF, 24 were evaluated. Among the 19 children who met diagnostic criteria for DCD (IQ > 70, M-ABC < 16th percentile), 37% ( n = 9) were left-handed. Among children who scored at or below the fifth percentile of the M-ABC, 46% were left-handed (6/13).

Conclusion:

The prevalence of left-handedness in children with DCD suggests a possible role for cerebral lateralization in motor coordination problems.
Course and Outcome after the First Manic Episode in Patients with Bipolar Disorder: Prospective 12-Month Data from the Systematic Treatment Optimization Program for Early Mania Project
Authors: Yatham Lakshmi N , Kauer-Sant'Anna Marcia , Bond David J , Lam Raymond W , Torres Ivan
Published: January 2017

Objective:

To describe clinical characteristics, course, and outcome during a 1-year period after the first manic episode in patients with bipolar disorder (BD).

Methods:

This paper describes the project design, demographics, clinical outcomes, and predictors at 6 months to 1 year of follow-up of the first 53 recruited subjects with first-episode mania from the Systematic Treatment Optimization Program for Early Mania.

Results:

Survival analysis for recurrence of mood episodes showed that 46.7% of patients survived without a mood episode during 1-year of follow-up, and the mean time-to-mood event was 7.9 months. Earlier age of onset was the only variable that significantly predicted recurrence of mood episodes. When examined separately, the survival rates were 76% for a manic episode and 58.7% for a depressive episode.

Conclusion:

These results suggest that recurrences are common after the first manic episode with more than one-half of the patients experiencing a mood event within 12 months. Aggressive treatment strategies aimed at preventing depressive episodes are needed in the management of early course BD.
Childhood Disruptive Behaviour Disorders: Review of Their Origin, Development, and Prevention
Authors: Petitclerc Amélie , Tremblay Richard E
Published: January 2017

Objective:

To review preventive studies of disruptive behaviour disorders (DBDs) in light of recent empirical knowledge on their development.

Method:

We draw on the results of longitudinal studies of children starting in infancy to examine the onset, development, and risk factors for DBD symptoms. We review randomized controlled trials of preventive interventions provided to families before the child is aged 3 years, with reported outcome measures of DBD symptoms at follow-up.

Results:

Children who present high levels of DBD symptoms start to do so in the first 2 years of life and have risk factors that can be identified in the mother during pregnancy or even earlier, and shortly after the child's birth. Most preventive experiments have started relatively late after birth and have targeted parenting, with weak effects on children's DBDs. Preventive experiments that have provided intensive intervention to at-risk mothers starting during pregnancy have shown important effects in reducing key risk factors and some of the most severe consequences of DBDs. However, even those experiments have not succeeded in preventing childhood DBDs in the home and school contexts.

Conclusions:

We suggest adopting a sequential, multitarget, intergenerational, experimental approach both to increase our knowledge about causal mechanisms and to increase our effectiveness in curbing DBDs and their serious lifelong consequences.
Complementary Development of Prevention and Mental Health Promotion Programs for Canadian Children Based on Contemporary Scientific Paradigms
Authors: Breton Jean-Jacques
Published: January 2017

Confusion regarding definitions and standards of prevention and promotion programs is pervasive, as revealed by a review of such programs in Canada. This paper examines how a discussion of scientific paradigms can help clarify models of prevention and mental health promotion and proposes the complementary development of prevention and promotion programs. A paradigm shift in science contributed to the emergence of the transactional model, advocating multiple causes and dynamic transactions between the individual and the environment. Consequently, the view of prevention applying over a linear continuum and of single stressful events causing mental disorders may no longer be appropriate. It is the author's belief that the new science of chaos theory, which addresses processes involved in the development of systems, can be applied to child development and thus to the heart of prevention and promotion programs. Critical moments followed by transitions or near-chaotic behaviours lead to stable states better adapted to the environment. Prevention programs would focus on the critical moments and target groups at risk to reduce risk factors. Promotion programs would focus on stable states and target the general population to develop age-appropriate life skills. The concept of sensitive dependence on initial conditions and certain empirical studies suggest that the programs would have the greatest impact at the beginning of life. It is hoped that this effort to organize knowledge about conceptual models of prevention and mental health promotion programs will foster the development of these programs to meet the urgent needs of Canadian children.
Acute Chest Syndrome in Sickle Cell Disease: Pathophysiology and Management
Authors: Claster Susan , Vichinsky Elliott
Published: January 2017

Acute chest syndrome (ACS) is defined as the development of a new pulmonary infiltrate and respiratory symptoms in a patient with sickle cell disease (SCD). One of the most serious complications of SCD, ACS is the leading cause of mortality in patients with SCD. ACS is age dependent, with children having milder disease that often is infectious. Adults often have more severe disease, with pulmonary fat embolism secondary to preceding long bone infarction frequently as a contributing factor. Rapid diagnosis and a high index of suspicion are crucial since this syndrome may have a high mortality rate. A high white blood cell count and a felling hemoglobin tend to be associated with this illness. Patients are often febrile, but may not have positive blood or sputum cultures. Appropriate therapy includes judicious fluids, close attention to respiratory care, antibiotics, and transfusion therapy. Use of the drug, hydroxyurea, has been shown to decrease the incidence of ACS. Patients with repeated episodes are at risk for the development of chronic lung disease and pulmonary hypertension. New treatment strategies such as inhibitors of cytokines and pulmonary vasodilators such as nitric oxide may reduce the high mortality of ACS.
Chest Tubes: Indications, Placement, Management, and Complications
Authors: Gilbert Timothy B. , McGrath Brian J. , Soberman Mark
Published: January 2017

Use of tube thoracostomy in intensive care units for evacuation of air or fluid from the pleural space has become commonplace. In addition to recognition of pathological states necessitating chest tube insertion, intensivists are frequently involved in placement, maintenance, troubleshooting, and discontinuation of chest tubes. Numerous advances have permitted safe use of tube thoracostomy for treatment of spontaneous or iatrogenic pneumothoracies and hydrothoracies following cardiothoracic surgery or trauma, or for drainage of pus, bile, or chylous effusions. We review current indications for chest tube placement, insertion techniques, and available equipment, including drainage systems. Guidelines for maintenance and discontinuation are also discussed. As with any surgical procedure, complications may arise. Appropriate training and competence in usage may reduce the incidence of complications.
Clinical Education and Postgraduate Training Opportunities in Nephrology Pharmacy
Authors: Halstenson Charles E.
Published: January 2017

All colleges of pharmacy in the United States were surveyed to assess the availability of didactic and clinical pharmacotherapy education in the field of nephrology. Forty-four of the 54 (81.5%) colleges with PharmD programs responded to the survey. Of these programs, 64% (28/44) teach nephrology as a separate module during the PharmD curriculum. The content of the nephrology curriculum varied from 2 lecture hours to 30 lecture hours. The pharmacokinetic concepts that relate to pharmacotherapeutic management of nephrology patients are taught in a separate nephrology course in only 9% of these 28 programs. In 57% of these PharmD programs, pharmacokinetic concepts inherent to nephrology are taught as part of a separate pharmacokinetic course. There are 34% of the programs that teach these pharmacokinetic principles in both the nephrology course and as part of a separate pharmacokinetic course. Of the 44 PharmD programs that responded to the survey, 23 (52%) have elective nephrology clerkships. Ten postgraduate training opportunities in nephrology are offered by nine individuals in association with eight colleges of pharmacy. Seven programs have a primary focus in nephrology, three residencies and four fellowships, while three programs identify nephrology as a secondary focus: one residency and two fellowships. An additional eight postgraduate training opportunities with a significant nephrology component were identified. Some of these transplantation residencies and fellowships provide a focused experience in renal transplantation while others include liver, lung, heart, and/or bone marrow experiences. The newest nephrology postgraduate educational opportunity is the American Society of Hospital Pharmacists (ASHP) Clinical Pharmacy Dialysis Service Traineeship Program, which was established in 1992. Implementation of the program was directed by the ASHP Research and Education Foundation with funding from Amgen, Inc. This postgraduate training experience is designed to prepare a pharmacist practitioner to establish and maintain a specialized service for the pharmacotherapeutic management of patients undergoing dialysis.