bluuebunny/crossref_metadata_2025 huggingface dataset:
What are the Symptoms of Psychosis?
Authors: Compton Michael T , Broussard Beth
Published: November 2020

Before learning about the symptoms of psychosis, it is important to understand what doctors mean by the words symptoms, signs, syndromes, and diagnosis. In this chapter, we explain these four words and then describe the various symptoms of early psychosis. Nearly any illness, whether it affects the body or the brain, causes symptoms. A symptom is an obvious change from one’s normal health that happens when an illness or disease occurs. For example, symptoms of a heart attack may include chest pain, pressure in the chest, pain running down the left arm, problems breathing, nausea, and sweating. Symptoms of the fl u may include fever, chills, cough, sore throat, and nausea. Symptoms often are the reason you go to a doctor or other health-care provider. The doctor then examines the patient to look for signs. Signs are like symptoms, but a doctor sees them through an interview, exam, or test, while symptoms are experienced by the patient. The patient may not even know that he or she has signs of an illness. For example, during a routine check-up, the doctor may discover that the patient has high blood pressure or high cholesterol. These signs could mean that the patient has heart disease or is at risk for a heart attack. Most medical diseases and mental illnesses cause both symptoms that patients experience and signs that doctors observe. A combination of both symptoms and signs is a syndrome. A heart attack is an example of a medical syndrome. Another example, diabetes, has symptoms such as being thirsty and frequent urination, and signs such as high levels of glucose, or sugar, in the blood. Some other medical syndromes are an ear infection, the flu, arthritis, and stroke. There also are many types of mental illness syndromes, such as depression, panic attacks, psychosis, and dementia. This book focuses on the syndrome of psychosis. It especially focuses on the first time psychosis appears, usually between the ages of 16 and 30 years. The word diagnosis (plural, diagnoses) refers to the specific medical word(s) given to an illness or syndrome by health-care providers. Examples of medical diagnoses include “diabetes mellitus” (diabetes), “acute myocardial infarction” (heart attack), and “cerebrovascular accident” (stroke).
What Diagnoses are Associated with Psychosis?
Authors: Compton Michael T , Broussard Beth
Published: November 2020

As described in Chapter 1, psychosis is a syndrome. This syndrome can include a number of different signs and symptoms (see Chapter 2 on What Are the Symptoms of Psychosis?). In this chapter, we discuss the different diagnoses that may relate to psychosis. A diagnosis is a specific medical term given to an illness or syndrome by health-care providers. When a doctor evaluates someone experiencing psychosis, he or she gathers as much information as possible. This information comes from a detailed psychiatric interview and observations, medical records, additional information from family members, a physical exam, cognitive assessments, lab tests, and other types of evaluations to determine the illness underlying the episode of psychosis (see Chapter 5 on The Initial Evaluation of Psychosis). While gathering information to evaluate a first episode of psychosis, the doctor often comes up with a differential diagnosis. This is a list of the most likely reasons for the syndrome, in this case, psychosis. Doctors generally use a differential diagnosis to list the possible illness underlying any health problem. For example, if you go to the doctor for a fever, the doctor may make a list of possible reasons for the fever, such as a minor nose cold caused by a virus, strep throat caused by bacteria, pneumonia, meningitis, or other infections. To narrow down this list to the most likely diagnosis, the doctor then uses information from the history (asking questions), physical exam, and lab tests. Oftentimes a doctor uses a working diagnosis to guide treatment planning even if he or she has yet to decide on a final diagnosis. It is important for patients and families to recognize that making a specific diagnosis often requires long-term information that often is not fully available when a person first comes in for treatment. Being unsure about the diagnosis is one reason why a differential diagnosis and a working diagnosis are so important. A working diagnosis allows the doctor to begin an effective treatment plan even though a final diagnosis may not yet be clear. Some patients and families may want to get a specific diagnosis and may be skeptical when the doctor cannot yet definitively provide one.
Understanding Mental Health First Aid for Psychosis
Authors: Compton Michael T , Broussard Beth
Published: November 2020

Throughout this guide, we have tried to explain all parts of a first episode of psychosis in a detailed way. But what happens if you know someone who may be experiencing an episode of psychosis and you have to act fast or help them get into treatment? This last chapter includes advice on how to provide mental health “first aid” to those who may be experiencing an episode of psychosis. These guidelines were developed by and reprinted here with permission from Professor Anthony Jorm and Ms. Betty Kitchener from the University of Melbourne and ORYGEN Research Centre in Melbourne, Victoria, Australia. As a result of an extensive process, they are based on the agreement of a panel of patients, family members, and mental health professionals from Australia, Canada, New Zealand, the United Kingdom, and the United States. For more information on their Mental Health First Aid program, please visit www.mhfa.com.au. The remainder of this chapter is organized around nine questions that are addressed to help people who may need to provide “first aid” to someone experiencing psychosis. The purpose of these guidelines is to help members of the public to provide first aid to someone who may be experiencing psychosis. The role of the first aider is to assist the person until he or she receives appropriate professional help or the crisis resolves. These guidelines are a general set of recommendations about how you can help someone who may be experiencing psychosis. Each individual is unique, and it is important to tailor your support to that person’s needs. So, these recommendations will not be appropriate for every person who may have psychosis. It is important to learn about the early warning signs of psychosis and the symptoms of psychosis so that you can recognize when someone may be developing psychosis. Although some of these signs may not be very dramatic on their own, when you consider them together, they may suggest that something is not quite right. It is important not to ignore or dismiss such warning signs or symptoms, even if they appear gradually and are unclear.
Strategies for Primary and Secondary Prevention of HIV Transmission
Authors: Cohen Mary Ann , Goforth Harold W.
Published: November 2020

Since HIV disease was first recognized three decades ago, numerous efforts have been made to prevent its continued transmission. The Centers for Disease Control and Prevention (CDC) estimates that more than 56,000 Americans become infected each year—one person every 9 1/2 minutes—and that more than one million people in this country are now living with HIV (CDC, 2008, 2009;Hall et al., 2008). The CDC estimates that roughly 1 in 5 people infected with HIV in the United States is unaware of his or her infection and may be unknowingly transmitting the virus to others (CDC, 2008). Over the past 15 years, many behavioral HIV risk reduction interventions have been developed, with prevention efforts targeting mostly HIV-negative individuals and focusing almost exclusively on HIV testing and counseling. More recently, comprehensive HIV prevention has involved both primary and secondary prevention activities to decrease the number of new HIV infections and associated complications, respectively (Marks et al., 2006; O’Leary and Wolitski, 2009). Psychiatric factors both complicate and perpetuate the HIV pandemic as a result of unsafe sexual practices and substance use disorders. In this chapter, we describe some of the psychiatric and psychodynamic factors that lead to HIV transmission and present novel strategies to assist clinicians and health-care policymakers in prevention efforts. Primary prevention is defined as any activity that reduces the burden of morbidity or mortality from disease; it is to be distinguished from secondary prevention, in which activities are designed to prevent the complications of already existing disease. In the case of HIV, primary prevention efforts focus on strategies designed to prevent the transmission of HIV—keeping seronegative people seronegative. In the HIV pandemic, however, many prevention strategies share characteristics of both primary and secondary efforts, so the distinction is somewhat artificial. Multiple prevention strategies have been devised, and these center around HIV counseling, substance abuse programs, and HIV prevention and intervention programs for children. Counseling healthy pregnant women, uninfected children, adolescents, adults, and older persons about HIV risk reduction and providing information about sexual health are important components to primary prevention strategies, but few physicians and other clinicians actually do this unless it is a part of a program specifically designed to prevent HIV transmission.
Diagnosis of Psychiatric Disorders
Authors: Batista Sharon M. , Goforth Harold W.
Published: November 2020

As we enter the third decade of the AIDS pandemic, persons with AIDS are living longer and healthier lives as a result of appropriate medical care and advances in antiretroviral therapy. In the United States and throughout the world, however, some men, women, and children with AIDS are unable to benefit from this medical progress because of inadequate access to care. A multiplicity of barriers involving economic, social, political, and psychiatric factors contribute to this lack of access. For this and other reasons, psychiatric factors take on new relevance and meaning in this stage of the pandemic (Cohen, 2008). Psychiatric disorders and distress play a significant role in the transmission of, exposure to, and infection with HIV. They are thus relevant to HIV prevention, clinical care, and adherence to treatment throughout every aspect of illness from the initial risk behavior to death. Psychiatric disorders can result in considerable suffering, from diagnosis to end-stage illness. Persons with HIV and AIDS may have no psychiatric diagnosis at all or any diagnosis described in psychiatric nomenclature (Cohen and Alfonso, 2004; Cohen, 2008). In this chapter, we provide guidelines for the diagnosis of those psychiatric disorders that are most likely to complicate and perpetuate the HIV pandemic and pose diagnostic dilemmas for clinicians. Although we introduce aspects of treatment of each disorder, please see Chapters 7, 8, 9, 10, 11, and 12 for detailed descriptions of psychotherapeutic and psychopharmacological treatment approaches to AIDS psychiatry. Consideration of a broad differential diagnosis is paramount in evaluating behavioral disorders in persons with HIV, especially when investigating medical and neuropsychiatric etiological factors related to HIV illness and its treatment. Since few persons with HIV have access to psychiatrists or other mental health clinicians, and even fewer have access to an AIDS psychiatrist, a summary of suggested key questions is provided here to aid HIV clinicians in detecting the underlying psychiatric diagnoses most frequently encountered in persons with HIV and AIDS. While these questions are by no means a substitute for comprehensive psychiatric evaluation (described in detail in Chapter 2 of this handbook), they can inform clinicians of the need for further assessment, emergency intervention, or referral to a psychiatrist.
Psychopharmacologic Treatment Issues in AIDS Psychiatry
Authors: Cozza Kelly L. , Goforth Harold W.
Published: November 2020

Persons with HIV and AIDS are often prescribed a plethora of medications, all of which require special attention and are based on well-defined principles. In the first part of this chapter, Drug Interaction Principles, we provide a short but essential review of these principles in order to prepare the reader to critically weigh the potential for drug interactions between psychotropics and antiretroviral therapy (ART) and those between ART and other medications. In the second part, Psychotropics and HIV, a brief review of the available literature on the effectiveness of psychotropics in treating patients with HIV is provided, followed by an overview of issues relating to drug interactions for each psychotropic or class of psychotropic. The third part of the chapter, Antiretrovirals, provides an introductory overview of currently available antiretrovirals and of medications prescribed in treating HIV/AIDS. Readers are referred to an excellent review of pharmacological treatment for persons with addictions and HIV/AIDS, by Wynn and colleagues (2005), and to Chapters 2, 6, 8, and 10 of this handbook for more information on treating substance abuse and dependence. Understanding drug–drug interactions in the care of HIV patients is essential. For a full explanation of psychotropic pharmacology and drug interactions, the reader is referred to additional texts on the subject (Cohen and Gorman, 2008; Schatzberg and Nemeroff, 2009; Wynn et al., 2009). Pharmacodynamic interactions are those that occur at the intended receptor site of a medication and involve absorption, distribution, metabolism, and excretion. ART drugs may be affected by timing with food or buffers, which is relatively predictable. Metabolic interactions are a bit more complex, as they are affected by metabolic inhibition, induction, and pharmacogenetics (the particular metabolic enzymes that a patient is born with). Metabolic interactions may occur in either phase I or II metabolic enzymes and also may include the cell membrane transporter enzymes (also known as p-glycoproteins). For a complete explanation of pharmacokinetic interactions, the reader is referred to the text by Wynn et al. (2009).
Symptoms Associated with HIV and AIDS
Authors: Goforth Harold W. , Cohen Mary Ann
Published: November 2020

Many persons with HIV and AIDS have symptoms that are unrelated to underlying psychiatric disorders but may masquerade as such. These symptoms may include insomnia, fatigue, nausea, or other troubling symptoms, and often result in suffering for patients, their families, and loved ones. The symptoms are common throughout the course of HIV and AIDS, from onset of infection to late-stage and end-stage AIDS. They need to be addressed whenever they occur and not only as part of end-of-life care. We present protocols to ameliorate or eliminate these symptoms and alleviate suffering. Fatigue is one of the most prevalent but underreported and undertreated aspects of HIV disease. The prevalence of fatigue in an HIV population has been estimated to affect at least 50% of seropositive individuals (Breitbart et al., 1998) and may affect up to 80% of the population. Darko and colleagues (1992) found that HIV-seropositive individuals were more fatigued, required more sleep and daytime naps, and showed less alert morning functioning than did persons who are HIV-seronegative. While the symptom of fatigue may fluctuate with increasing viral loads, there is no evidence base for a consistent correlation between fatigue and viral load. Fatigue is a pseudo-specific symptom common to a variety of disabilities found in an HIV population, and it has been linked to a variety of other AIDS-related disabilities including pain, anemia, impaired physical function, psychological distress, and depression. Hormonal alterations, such as those in testosterone and thyroxin, that occur in the context of HIV infection are also common in this group. While these findings are further discussed in Chapter 10, it is worth noting here that they can contribute substantially to tiredness and fatigue in this population. Other sources of fatigue include multimorbid chronic illnesses (opportunistic infections and cancers, chronic renal insufficiency, hepatitis C and other hepatic illnesses, and chronic obstructive pulmonary disease [COPD]) and some of their treatments (notably interferon/ribavirin for hepatitis C and cancer chemotherapy). Substances such as recreational drugs, nicotine, and caffeine are also factors in HIV-related fatigue.
Building Love’s Canal
Authors: Newman Richard S.
Published: November 2020

The fall from environmental grace that Mark Twain described was a product of sweeping industrialization at the close of the 19th century. Spurred by the advent of hydroelectric power, a whole new group of commercial schemers flooded the Falls in search of wealth, power, and prestige. “This is an electrical era,” a Niagara booster bragged. “Back in the centuries that are past, we had the stone age, the ice age, etc., but the electrical age is purely the utilization of natural forces by the genius of man.” “Naturally,” he noted, “the first development of electric power was at the source of the greatest quantity of power anywhere to be found on earth, the Falls of Niagara.” That meant Niagara Falls would remain a watchword of industrial expansion far into the future. Among the legion of businessmen, engineers, and investors flocking to the fin de siècle Falls was an unheralded entrepreneur named William Love. After surveying the area in the early 1890s, Love was smitten. The environment he encountered was beautiful and bountiful. He soon unleashed bold plans to build both the world’s greatest hydroelectric power canal and “a model manufacturing city” that might someday encompass millions of people. By offering cheap power to businesses and an array of modern amenities to residents, Love’s Model City would become “the most complete, perfect and beautiful” urban locale “in the world.” As Love told anyone who would listen, his plan was destined to succeed. History knows Love for his dramatic failure. The economic crisis of 1893 undercut investments in Model City, while Love’s tangled business plans killed construction of his power canal. By the early 1900s, Love was long gone. In Model City, located a few miles from the Falls, little remained of his epic vision, save for a few small buildings. Yet in the town of Lasalle, an environmental ruin associated with Model City remained a prominent part of the landscape for many years: “Love’s Canal.” Before Love’s funding evaporated, his workers excavated a portion of a power canal and waterfall that would have been higher and more powerful than the natural Falls.
The Master of the Chemical Machine
Authors: Newman Richard S.
Published: November 2020

Model’s City’s demise did little to slow industrial growth in Niagara Falls. During the early 1900s, the region’s economy expanded at a tremendous rate. Niagara’s next big thing came in the form of chemicals. When William Love departed the area, the Falls claimed no major chemical maker. By the 1920s, Niagara Falls was home to a dynamic and thriving chemical sector that produced huge amounts of industrial-grade chemicals via hydroelectric power. By World War II, dozens of companies called Niagara Falls home, making it a global leader in the production of chlorines, degreasers, explosives, pesticides, plastics, and myriad other chemical agents. The chief architect of Niagara’s chemical expansion was Elon Huntington Hooker, an engineer turned industrial titan who settled in the Falls soon after William Love left. [ Fig. 6 ] Hailing from famous families, Hooker was destined for great things. On one side, Hooker could trace a lineage back to Puritan divines who had literally built cities on a hill; on the other, there were railroad titans who had traversed the American West. In both cases, Elon Hooker’s family background inspired him to think big. The guiding spirit of a brash new chemical company that bore his surname, Hooker harnessed Niagara’s power to become the nation’s leading producer of two key chemicals: chloride of lime (bleaching powder) and sodium hydroxide (caustic soda). Over the next fifty years, Hooker Chemical became a mainstay of American industry. Its products helped win wars, explore space, and fuel American consumerism. These developments would not surprise Elon Huntington Hooker. Indeed, he thought of himself as an American Adam: a technological originator who reshaped nature and society in equal measure. His vision of chemical superiority would come to fruition a few miles from Love’s abandoned canal—at first glance, perhaps nothing more than a coincidence of history. But Hooker’s success would soon collide with Love’s failure at the big ditch in Lasalle, once again illuminating the Love Canal landscape’s importance to the American environmental past—and future.
A Toxic Subdivision
Authors: Newman Richard S.
Published: November 2020

For most Love Canal residents in the mid-1970s, owning a house in a relatively new subdivision offered tangible proof that they had achieved the American Dream. The pretty tree-lined streets bisecting the ten-block neighborhood colloquially known for the old canal that once ran through the area contained rows of attractive and affordable housing stock. Kids walked to schools located only blocks away while their parents talked to one another like longtime friends. Many area fathers had secure, well-paying jobs in Niagara Falls’ thriving industrial and chemical sectors, lending an aura of confidence to Love Canal life. While many American communities were still reeling from the tumultuous politics of the Vietnam War, the Love Canal neighborhood appeared to be a quiet, family-friendly oasis. Who wouldn’t want to live there? Lois Gibbs, a young housewife and mother of two who moved into the area in 1974, certainly felt blessed. “If you drove down my street before Love Canal,” she would later write (referring to the crisis that redefined the place), “you might have thought it looked like a typical American small town that you would see in a movie—neat bungalows, many painted white, with neatly clipped hedges or freshly painted fences.” It was, she continued, a “lovely neighborhood in a quiet residential area, with lots of trees and lots of children playing outside.” So powerful was the sense of paradise that Gibbs did not pay much attention to early news reports about a leaking toxic dump somewhere in Niagara Falls. Those poor people, she thought. Wherever they are, I hope they will get the help they need. Thankfully, it was not her neighborhood. Like many of her friends, Gibbs focused on family and home, not the looming tragedy of hazardous waste—and certainly not the global cause of environmental justice. A snapshot of the Love Canal area during the tumultuous summer of 1978 offered a completely different picture. Gone were the peaceful images of home life; in their place, illness, uncertainty, and rage reigned supreme.
Creative Destruction
Authors: Newman Richard S.
Published: November 2020

Although the tenth anniversary of the crisis pictured Love Canal as a thing of the past, the area still inspired dreams of development in the future. That became clear in September 1988, when Health Commissioner David Axelrod returned to Niagara Falls to announce that the state would back Love Canal resettlement. The longtime mayor of Niagara Falls, Michael O’Loughlin, beamed at the news. This was the first “positive statement about Love Canal” in years, he said. Axelrod’s resettlement recommendation was the result of a five-year, $14 million study. Using massive amounts of test data, the study drilled down into Love Canal’s new nature to see if the monumental remediation plan had worked. The study determined that parts of the ten-block Emergency Declaration Area (EDA) had acceptable chemical levels and only slightly higher contamination risks than comparison areas hard by landfills, steel plants, and old manufacturing facilities in the American Rust Belt. While no one could certify the neighborhood’s absolute safety, Axelrod proposed that people might soon move into sections of the nearly empty subdivision. Former residents again fumed at Axelrod. Joann Hale called Axelrod’s decision “piece meal,” at best, and dangerous at worst. Anything but a “black and white” answer about the safety of resettlement was wrong. The ETF’s Roger Cook said that resettlement posed “unacceptable risks” to future residents. Janet Ecker, a former resident not known for screaming and shouting, told a reporter that Axelrod’s announcement was “very sad.” “I don’t agree it is a safe place. The chemicals don’t know that they’re supposed to stop” at certain places. The mere mention of Love Canal brought back unhappy memories to Ecker, who left in 1980 for Florida and was still “glad to be as far away as I can get from that place.” Lois Gibbs went even further: it was morally wrong for the state to resettle the area. As these divergent perspectives on Axelrod’s announcement indicated, Love Canal remained a hotly contested environment well after final evacuation had occurred.
Water for Life
Authors: van Santen Rutger , Khoe Djan , Vermeer Bram
Published: November 2020

Over a billion people don’t have access to a safe water supply. And a third of the world’s population lacks basic sanitation with the result that more than 2 billion human beings are afflicted with infections that result in diarrhea and other diseases. Tens of millions of them die every year. Improving this state of affairs poses a massive challenge. Take sanitation: What if we could provide basic facilities for all those people over the next 20 years? You’d have to hook them up to the sewer system at the rate of half a million a day. We know how to install individual toilets and sewage pipes, but a project on that kind of scale is way beyond our capabilities. It would not only require new technology but a huge amount of money and political will, too. The challenges for providing all humanity with access to clean water are similarly gigantic. It’s not a matter of scarcity. There is enough drinking water for everyone on Earth even as its population continues to grow. According to the United Nations, a human being needs 20 liters of drinking water a day to live healthily. Every year, 100,000 cubic kilometers of rain fall on the earth, which translates into 40,000 liters per person per day. That would be plenty even if you only manage to tap a tiny fraction. Sufficient drinking water is available for all even in the driest regions of the earth. The problem is one of quality: People don’t die of thirst; they die from drinking water that’s not safe. The use of water for agriculture is another story. Roughly 70 percent of the human use of fresh water is for farming. People rarely realize just how much water agriculture requires. It takes 1,000 liters to grow the wheat for a single kilogram of fl our, for instance. Other products soak up even larger amounts of water. A kilogram of coffee needs 20,000 liters, and a liter of milk takes 3,000—mostly for the cattle feed and the grass consumed by the cow.
Agenda
Authors: van Santen Rutger , Khoe Djan , Vermeer Bram
Published: November 2020

We have some serious work to do. Far too many people lead miserable lives because they lack the most basic necessities to deal with hunger, thirst, shelter, disease, or disability. In addition, the prosperity currently enjoyed by many of us may not be taken for granted in the future. The experts in this book have identified a range of breakthroughs that are urgently required if we are to improve the fate of humanity in the decades ahead and look to the future with greater confidence. There will be some hard choices, and some lines of research will probably need to be pursued at the expense of others. Industry should change and adopt new strategies. And we as a society should accept and foster that change. The evolution of technology, industry, and society is a complex process full of feedback mechanisms and surprises. It’s vital that we understand the most promising ways to facilitate the necessary changes of direction. The technologies proposed in this book aren’t straightforward; otherwise, they would have been identified much sooner. The days when you could produce a brilliant invention in your garden shed have largely gone. Anyone wishing to improve the current state of technology needs a solid pedigree and will need to labor long and hard with a group of dedicated colleagues, in many cases relying on extremely expensive equipment. Breakthroughs demand the stamina, laborious testing, and inspiration of countless scientists and engineers. Hundreds of thousands of design hours can go into a new microchip, car, or power-generation technique. Developing new technology is a complex process. That complexity is exemplified by the development of the laser. Einstein predicted the principle of stimulated emission on which lasers are based long before World War II. But it was many more decades before working lasers were created and longer still before they were put to practical use. Once we had them, however, we found we could use them in new scientific instruments that opened up fresh areas of research.
How Can Existing Mood Scales Be Improved? How to Test, Refine, and Improve Existing Scales
Authors: Smith Adam B.
Published: November 2020

Many scales and tools have been developed by expert opinion. Several methods are available by which tools can be field tested in order to more accurately gauge their diagnostic potential. Promising new methods including item banks and computer-adaptive tests are under development to maximize the efficiency of screening tools for depression. Various methods are available to diagnose psychiatric disorders (see Chapter 2), but in the absence of a formal semi-structured psychiatric assessment, which remains impractical, the most commonly used method for assessing and screening levels of emotional distress remains by self-completed questionnaire. There have been many hundreds of validation attempts, comparing the severity questions against clinical judgment, semi-structured interviews, DSM and ICD criteria, and of course each other. Almost universally in primary care, community, and specialist settings, their accuracy is imperfect and further refinement is required. When tested according to their ability to enhance the detection and quality of care for depression, the efficacy of these instruments remains modest. A recent review from Gilbody and colleagues found that screening and case-finding instruments were associated with a modest increase in the recognition of depression by clinicians (relative risk [RR] 1.27, 95% confidence interval [CI] 1.02 to 1.59) and only a borderline significant effect on the overall management of depression (RR 1.30, 95% CI 0.97 to 1.76). Seven studies provided data on the impact of screening on depression outcomes, but there was no evidence of an effect (standardized mean difference –0.02, 95% CI –0.25 to 0.20). No doubt some of the problem lies with the organizational elements that may (or may not) accompany screening and some lies with clinicians’ willingness to treat a probable case. However, some blame also lies with the instruments themselves, as most were developed by expert opinion rather than by a scientific process. The quantitative methods that enable evaluation of the diagnostic accuracy of severity scales are discussed in Chapter 5. However, the evaluation of scales should be viewed in a wider context of tool development (Table 4.1). In the preclinical phase a tool is developed, often in the case of depression borrowing from existing scales and usually by consensus rather than by scientific testing. In phases I and II preliminary testing occurs, ideally in the clinically representative sample with several competing comparison groups.
Technological Approaches to Screening and Case Finding for Depression
Authors: Rogers William H. , Lerner Debra
Published: November 2020

What are the strengths and weaknesses of computer-based and other automated methods of detecting depression? Two promising technologies make use of the Internet and speech recognition. Whatever technology is used, each method needs to be assessed rigorously using the same high standards that have been applied to pencil-and-paper tests. We are in the midst of a technological revolution that inevitably will transform psychiatric clinical practice. A consensus for routine depression screening is building, and at the same time methods by which it could be accomplished are emerging. The hope is that the right technology can provide an easy, inexpensive, valid, and reliable public health approach to depression screening. Computerized assessment is well accepted in diverse fields, and the use of Internet-based survey technology has grown exponentially. Issues regarding the strengths and limitations of computerized assessments are addressed regularly in the literature. For example, such assessments have been shown to improve data quality while at the same time reducing cost as well as the time to score, analyze, and report results. Increasingly, as depressive disorders have been recognized as highly prevalent with significant morbidity, multiple screeners using an array of technological advances have been developed (Table 8.1 lists selected studies). This chapter will review the technologies that are currently available for automated depression screening and will discuss them in terms of criteria that should dictate their adoption. The growing list of technologies can be classified on several dimensions. Perhaps themostimportant of these isadaptivevs.non-adaptive. Inanadaptive technology pioneered by the Educational Testing Service, a computer, using a preprogrammed algorithm, decides which question to ask next given the responses so far. Paper-and-pencil is the classical non-adaptive technology— everyone gets the same paper with the same questions in the same order. Technological modality is a second dimension. Currently available technologies include the phone, the Internet, and hand-held electronic devices. The phone can be split into several groups, including agent: computer-assisted telephone interview (CATI), speech recognition, and touch-tone. Phone can also be classified as inbound (the patient initiates the call to a toll-free number) or outbound (the system initiates the call).
Screening for Depression in Medical Settings: Are Specific Scales Useful?
Authors: Parker Gordon , Hyett Matthew
Published: November 2020

There are two broad strategies for screening and quantifying depression in medical settings. The first approach is replying upon measures developed in psychiatric samples, and the second approach is to concede that symptoms are substantially different and to develop customized scales. Here we discuss the merits of several specific scales for measuring depression in physical settings and make the case for scales tailored to specific populations. A subsequent chapter (Babaei and Mitchell) will present a contrasting position. There are two broad strategies for screening and quantifying depression in medical settings. The first approach involves using measures developed in psychiatric samples and assuming that their relevance holds. The second approach is to concede that there are intrinsic limitations to extrapolating those ‘‘general’’ measures to medically ill populations. In the former case the hypothesis is that symptoms of depression are essentially the same when depression occurs with and without physical illness. In the latter case the hypothesis is the symptoms are substantially different. Pursuing the latter, there are two key concerns. Firstly, such an approach assumes some constancy to the nature of depression across differing psychiatric and medical settings. Depression, however, is difficult enough to define in psychiatric patient samples. Even ignoring the debate as to whether depression is viewed as comprising a set of subtypes or is best modeled along a continuum, quantifying clinical depression remains problematic, as detailed elsewhere in this book. Over the past few decades, clinical depression has most commonly been viewed as synonymous with major depression, but, as numerous studies have shown, comparable symptomatic distress and disability associated with major depression and minor depression—and even with subsyndromal depression—begs an obvious question: Can imposing a cutoff score on a dimensional measure of depression accurately distinguish true cases and true non-cases in a psychiatric sample? Further, assuming that a cutoff is derived with an acceptable classification rate, can we extrapolate decision rules derived from psychiatric samples to screen and quantify depression caseness in the medically ill? As measures that have been widely used for decades (such as the Zung and the Beck Depression Inventory) generate widely differing cutoff scores across psychiatric, general practice, and medical settings, there would appear to be quantitatively and possibly qualitative differences to the nature of depression in medical contexts, making general measure extrapolation problematic.
Screening for Depression in Cancer Care
Authors: Carlson Linda E. , Clifford Sheena K.
Published: November 2020

There is an increasing awareness of the importance of screening for depression and distress in oncology settings. Researchers have devised quick and simple methods for assessing symptoms in a wide range of patients that are acceptable to both patients and providers, and introduced computerized systems that make it possible to quickly screen a large number of patients efficiently. A large body of data concerning implementation of screening in cancer care seems to suggest that screening can serve to stimulate discussions of psychosocial and mental health issues between patients and oncology staff, but whether screening affects patient outcomes is still unclear. As with many other medical populations, people suffering with cancer are susceptible to clinical depression. More so than many other illnesses, cancer is associated with a poor prognosis and is in many ways synonymous with fear. References to the ‘‘Big C’’ and hushed tones prevailed in the past when a diagnosis of cancer was discussed, and remnants of these attitudes are still prevalent in many communities and countries worldwide. Hence, beyond the burden of the tumor and the associated treatment, the psychological toll of cancer is significant. Two thorough reviews of the prevalence of depression in cancer have been published in the past few years, and in addition to several other general reviews, summaries are available with reference to specific types of cancer (prostate, pancreatic, advanced disease) and specific patient groups (children and the elderly). Taking methodologic issues into consideration, the point prevalence of major depressive disorder and depression symptoms comorbid with cancer is most commonly cited between 10% and 25%.2 This rate varies considerably depending on how depression is measured (standard clinical interview, questionnaire), how it is conceptualized, the criteria used to define depression, the types of patients assessed (cancer type, demographics, inpatients versus outpatients), and the point during the cancer treatment trajectory when assessment occurs. Massie summarized 88 papers investigating depression prevalence in cancer patients: the highest rates of depression were found in head and neck, pancreatic, breast, and lung cancer patients (up to 50% of all patients), with lower rates generally reported in colon cancer, gynecologic cancer, and lymphomas (rates from 8% to 25%). The cancers with higher rates of depression generally have less positive prognoses (pancreatic, lung) or involve disfiguring treatments (head and neck, breast), perhaps explaining these discrepancies.
Commentary and Integration: Is it Time to Routinely Screen for Depression in Clinical Practice?
Authors: Coyne James C.
Published: November 2020

We were pleased we were able to convince such talented authors to contribute chapters to this volume. We hope that their contributions will serve to redefine key issues in the implementation of screening programs for depression in clinical settings. The chapters are quite varied but are notable for their balanced, evidence-based recommendations and skepticism about introducing screening into routine care unless there is a substantial infusion of resources. Taken together, the chapters provide a foundation for critiquing screening programs as they are currently being implemented. Screening has become the most commonly adopted enhancement of care for depression, even if questions can be raised about the fidelity with it is being implemented. Yet, the enthusiasm for screening is not based on the accumulation of compelling new evidence, but rather a reframing of the question of its efficacy, and the evidence is mustered to answer it. The crucial question has shifted from ‘‘Does routine screening improve patient outcomes?’’ to ‘‘Can screening be used to improve outcomes when there is a substantial effort made to ensure adequate treatment and follow up?’’1 This seemingly important difference has been downplayed in endorsements of screening. And yet, stand-alone screening programs are simply not effective in improving the management of depression in primary care (see Chapter 7). Moreover, including screening as a component in more comprehensive enhancements of care may not be necessary to improve outcomes. One can readily find basis in this volume for questioning the wisdom of stand-alone screening initiatives and for raising doubts whether routine screening is acceptable and sustainable in non-mental-health medical settings. I will highlight these points in the context of providing a more general commentary on the preceding chapters. One goal is to alert readers tempted by enthusiasm about screening to some frustrations and disappointments that await them if they proceed with a screening program without additional resources. I acknowledge that I am going beyond the conclusions of many chapters. However, almost all limit endorsement of screening to settings where supports are in place for absorbing the effects of screening and ensuring it has its intended effect. Unfortunately, such settings are far less common than presumed. So, the question becomes, ‘‘What are the implications of routine screening being implemented without such support?’’
Angle and Nonpenetrating Glaucoma Surgery
Authors: Wu Huijuan , Chen Teresa C.
Published: November 2020

The outflow of aqueous via the anterior chamber angle is a constant process. The aqueous is formed by the ciliary processes and then passes through the pupil from the posterior chamber to the anterior chamber (Figure 2.1). About 83%–96% of the aqueous finally exits the eye into the anterior chamber angle via the trabecular meshwork—Schlemm’s canal—venous system (i.e., the conventional or canalicular outflow pathway). The other 5%–15% of aqueous outflow occurs via uveoscleral outflow (i.e., the unconventional or extracanalicular outflow pathway), with aqueous passing through the ciliary muscle and iris, then entering into the supraciliary and suprachoroidal spaces, and then finally exiting the eye through the sclera or along the penetrating nerves and vessels. Glaucoma is usually associated with aqueous outflow problems through a variety of mechanisms. For the developmental glaucomas, the improper development of the outflow structures is the main reason for high eye pressures. In the primary and secondary open-angle glaucomas, the theories to explain the diminished outflow facility are numerous. Possible etiologies are as follows: deposition of foreign material (such as pigment, red blood cells, glycosaminoglycans, extracellular lysosomes, plaque-like material, and proteins) into the trabecular meshwork (TM) and the wall of Schlemm’s canal (SC), loss of trabecular endothelial cells, structural changes of the inner wall of SC, and abnormal phagocytic activity of trabecular endothelial cells. In angle closure glaucoma, the peripheral iris closes the entrance to the TM by the anterior pulling mechanism or the posterior pushing mechanism, resulting in the direct blockage of conventional outflow. The goal of angle and nonpenetrating procedures is to restore aqueous outflow, thereby lowering intraocular pressure (IOP). Angle surgery restores outflow by re-opening the natural channels for aqueous outflow, and nonpenetrating glaucoma surgery creates an artificial external filtration site and partly restores the normal physiologic pathways. In 1936, Otto Barkan was the first to describe a surgical procedure that creates an internal incision into trabecular tissue under direct magnified view of the anterior chamber angle.
Vitreous Prolapse and Lens Injury
Authors: Harasymowycz Paul J.
Published: November 2020

During trabeculectomy, when a sclerostomy and iridectomy are performed, the structures immediately posterior to the iris, namely the zonules, lens capsule, ciliary processes, and anterior hyaloid face may be violated, resulting in a variety of intraoperative and postoperative complications. Lens injury, including cataract formation, and vitreous prolapse are 2 of the complications that may occur intraoperatively. Cataract formation is one of the most common occurrences after trabeculectomy, reported in approximately 50% of cases. While development of the cataract is usually a slow process, it occurs more frequently in patients with a history of diabetes, postoperative flat anterior chambers, or intraocular inflammation, as well as in a patient with a negative spherical equivalent (preoperative lens status) and pseudoexfoliation syndrome. Older age is a risk factor, since natural cataract development may be accelerated; however, cataracts may develop in up to 25% of younger (<55 years of age) patients undergoing trabeculectomy. The utilization of postoperative steroids has also been implicated in the development of posterior subcapsular opacities. Although not a common occurrence, cataracts may also develop soon after surgery due to direct intraoperative surgical trauma to the lens. If the opacity is focal and does not encroach on or obstruct the visual axis, no further action may be needed. If there is obvious rupture of the lens capsule causing clinically significant inflammation that may compromise bleb development, urgent lens extraction should be performed. If the clinical situation permits, it is desirable to wait at least 3 months until the bleb matures. Rapidly forming cataracts may also develop due to prolonged contact between the lens and the cornea, such as occurs intraoperatively if forceps inadvertently indent the cornea while retracting the conjunctiva during a limbus-based trabeculectomy. Similarly, the lens may opacify if the anterior chamber is flat for an extended period of time before the scleral flap sutures are adequately tied. Likewise, postoperative hypotony with a flat anterior chamber may lead to cataract formation (see Chapter 10).