bluuebunny/crossref_metadata_2025 huggingface dataset:
Upper gastrointestinal surgery
Authors: Gardiner Matthew D. , Borley Neil R.
Published: January 2013

This chapter begins by discussing the basic principles of gastrointestinal physiology and nutrition in surgical patients, before focusing on the key areas of knowledge, namely gastro-oesophageal reflux disease and gastritis, peptic ulcer disease, gallstone disease, oesophageal neoplasia, gastric neoplasia, pancreatico-biliary neoplasia, and liver and spleen disorders. The chapter concludes with relevant case-based discussions.
Colonoscopy and flexible sigmoidoscopy
Authors: East James E. , Saunders Brian P.
Published: January 2013

Colonoscopy and flexible sigmoidoscopy are techniques for visualizing the lumen of the large bowel. In expert hands, after appropriate explanation to the patient (which increases the chances of the procedure being well tolerated), bowel preparation, and (usually) some form of ‘conscious sedation’, then total colonoscopy is possible in 98 to 99% of cases in the absence of obstruction, a severely ulcerated colon, or other contraindication....
Whipple’s disease
Authors: Hodgson H.J.F.
Published: January 2013

Whipple’s disease is an uncommon infection caused by the actinomycete Tropheryma whipplei. It is most commonly diagnosed when overt small-intestinal disease leads to malabsorption, but before this there are often several years of nonspecific prodromal manifestations such as fever and arthralgia/arthritis, and the disease can present in many other ways, e.g neurological manifestations (of many forms, including movement disorders, ocular manifestations and meningitis) or endocarditis....
Congenital abnormalities of the gastrointestinal tract
Authors: Wright V.M. , Walker-Smith J.A. , Sanderson I.R.
Published: January 2013

Congenital abnormalities of the gastrointestinal tract usually manifest shortly after birth, but on occasion symptoms may be delayed for months or even years. Any part of the gut can be affected, with problems including oesophageal atresia and tracheo-oesophageal fistula, anterior abdominal wall defects, congenital pyloric stenosis, atresia and stenosis of the small intestine, duplication of the gastrointestinal tract, small-intestinal malrotation with or without volvulus, small-intestinal lymphangiectasia, Meckel’s diverticulum, meconium ileus, congenital short intestine, colonic atresia, Hirschprung’s disease, and imperforate anus....
Disorders of cranial nerves
Authors: Hadden R.D.M. , Thomas P.K. , Hughes R.A.C.
Published: January 2013

The 12 cranial nerves are peripheral nerves except for the optic nerve which is a central nervous system tract. Disorders of particular note include the following: Olfactory (I) nerve—anosmia is most commonly encountered as a sequel to head injury.

Third, fourth, and sixth cranial nerves—complete lesions lead to the following deficits (1) third nerve—a dilated and unreactive pupil, complete ptosis, and loss of upward, downward and medial movement of the eye; (2) fourth nerve—extorsion of the eye when the patient looks outwards, with diplopia when gaze is directed downwards and medially; (3) sixth nerve—convergent strabismus, with inability to abduct the affected eye and diplopia maximal on lateral gaze to the affected side. The third, fourth, and sixth nerves may be affected singly or in combination: in older patients the commonest cause is vascular disease of the nerves themselves or their nuclei in the brainstem. Other causes of lesions include (1) false localizing signs—third or sixth nerve palsies related to displacement of the brainstem produced by supratentorial space-occupying lesions; (2) intracavernous aneurysm of the internal carotid artery—third, fourth, and sixth nerve lesions. Lesions of these nerves can be mimicked by myasthenia gravis....
Medical retina
Authors: Patil Bheema , Puri Pankaj
Published: January 2013

The chapter begins by discussing key clinical skills, namely fundus fluorescein angiography, abnormal fluorescein angiography, indocyanine green angiography, and electrophysiology. The following areas of clinical knowledge are then discussed: diabetic retinopathy, hypertensive retinopathy, retinal vein occlusion, retinal artery occlusions, age-related macular degeneration, intravitreal anti-VEGF injections, central serous chorioretinopathy, retinal vascular anomalies, retinal dystrophies, and choroidal dystrophies. The chapter concludes with eight case-based discussions, on gradual visual loss, central visual loss, visual loss in a hypertensive patient, sudden, painless visual loss, diabetic retinopathy, difficult night vision, visual loss in child, and macular lesion.
Cataract
Authors: Cleary Georgia , Spalton David
Published: January 2013

The chapter begins by discussing lens anatomy and embryology, before covering the key areas of clinical knowledge, namely acquired cataract, clinical evaluation of acquired cataract, treatment for acquired cataract, intraoperative complications of cataract surgery, infectious postoperative complications of cataract surgery, non-infectious postoperative complications of cataract surgery, congenital cataract, management of congenital cataract, and lens dislocation. Practical skills are then covered, including biometry, local anaesthesia, operating microscope and phacodynamics, intraocular lenses, and Nd:YAG laser capsulotomy. The chapter concludes with three case-based discussions, on age-related cataract, postoperative endophthalmitis, and posterior capsular opacification.
Strabismus and oculomotility
Authors: Ford Rebecca , Patel Moneesh
Published: January 2013

The chapter begins by discussing the anatomy and actions of the extraocular muscles and central control of ocular motility, before covering the key clinical skills, namely patient assessment, assessment of ocular movements, visual acuity testing, tests of stereopsis and binocular single vision, tests of retinal correspondence and suppression, and Hess charts. It then covers the key areas of clinical knowledge, including amblyopia, binocular vision and stereopsis, concomitant strabismus, incomitant strabismus, restrictive ocular motility disorders, complex ocular motility syndromes, vertical deviations , and alphabet patterns, and the key practical skills, namely the principles of strabismus surgery and other procedures in strabismus. The chapter concludes with five case-based discussions, on myopic anisometropia, esotropia, infantile esotropia, orbital floor fracture, and consecutive exotropia.
Neuro-ophthalmology
Authors: Sundaram Venki , Elston John
Published: January 2013

The chapter begins by discussing the visual pathway and pupil reflex anatomy and cranial nerve anatomy, before covering the key clinical skills, namely neuro-ophthalmology history taking, neuro-ophthalmology examination, and neuroimaging. It then covers the key areas of clinical knowledge, including chiasmal visual pathway disorders, retrochiasmal visual pathway disorders, optic nerve disorders, papilloedema and idiopathic intracranial hypertension, congenital optic nerve disorders, cranial nerve palsies, nystagmus, supranuclear eye movement disorders, pupil abnormalities, headache, non-organic visual loss, neuromuscular junction disorders, and ocular myopathies. The chapter concludes with five case-based discussions, on acute visual loss, sudden-onset diplopia, headache, anisocoria, and nystagmus.
Membranoproliferative glomerulonephritis
Authors: Glassock Richard J.
Published: January 2013

Membranoproliferative glomerulonephritis (MPGN, also known as mesangiocapillary glomerulonephritis) is a designation given to a very heterogeneous collection of disorders that manifest by light microscopy both mesangial hyper-cellularity and proliferation accompanied by broadening of the peripheral capillary loops (Holley and Donadio, 1994; Glassock et al., 1995; Strife and West, 2001; Glassock, 2008) due to reduplication of the glomerular capillary basement membrane (known as ‘double-contour’). In many instances, these broadened capillary loops also display prominent interposition of cells between the layers of the basement membrane and/or subendothelial or intra-membranous electron-dense deposits that may be accompanied by fragmentation or distortion of the basement membrane itself. The disorders encompassed by this definition also frequently display persistent reduction in serum complement levels (West et al., 1965).
Pulmonary hypertension
Authors: Kaski Juan Carlos
Published: January 2013

Introduction 308

Investigations/diagnosis 308

Classification/prognosis 309

Treatment 310

Clinical trials 314

Pulmonary hypertension (PH) is characterized by an increase in BP in the lung vasculature that leads to shortness of breath, dizziness, syncope, chest pain, and other symptoms, all of which are exacerbated by exertion. PH can be a severe condition with a markedly reduced exercise tolerance and lead to heart failure and death....
K
Authors: Dickman Andrew
Published: January 2013

This chapter includes drugs beginning with the letter K
M
Authors: Dickman Andrew
Published: January 2013

This chapter includes drugs beginning with the letter M
W
Authors: Dickman Andrew
Published: January 2013

This chapter includes drugs beginning with the letter W
The principles of clinical assessment in general psychiatry
Authors: Cooper John E. , Oates Margaret
Published: January 2013

This chapter is focused on the needs of the clinician in a service for general adult psychiatry, who has to carry-out the initial assessment of the patient and family, working either in the context of a multi-disciplinary team or independently. Within this quite wide remit, the discussion is limited to general principles that guide the practice of all types of psychiatry. The chapter does not include the special procedures and techniques also needed for assessment of children and adolescents, the elderly, persons with mental retardation, persons with forensic problems, and persons requiring assessment for suitability for special types of psychotherapy. It is assumed that the reader has already had significant experience of clinical psychiatry and has completed the first stages of a postgraduate psychiatric training programme. Therefore details of the basic methods recommended in commonly used textbooks or manuals of instruction for obtaining and recording information on essentials such as the history, personal development, mental state, and behaviour of the patient are not included in this chapter. Three topics have been given special attention. These are assessment by means of a multi-disciplinary team, the trio of concepts diseases, illness, and sickness, and the development of structured interviewing and rating schedules. The first two have a special connection that justifies emphasis in view of the recent increase in multi-disciplinary styles of assessment. For instance, when different members of the team appear to be in disagreement about what should be done, it is usually a good idea to ask the question: ‘What is being discussed—is it the patient's possible physical disease, the patient's personal experience of symptoms and distress, or the interference of these with social activities?’ It will then often become apparent that the issues in question are legitimate differences in emphasis and priority of interest, rather than disagreements. The third topic is given prominence in order to illustrate some aspects of the background of the large number of such schedules (or ‘instruments’) that are now available. They are usually given the shortest possible mention in research reports, but since most advances in clinical methods and service developments come from studies in which an assessment instrument has been used, clinicians should know something about them. The aim of the initial clinical assessment is to allow the clinician and team to arrive at a comprehensive plan for treatment and management that has both short-term and longer-term components. The achievement of this will be discussed under the following headings. ♦ Concepts underlying the procedures of assessment ♦ Contextual influences on assessment procedures ♦ Assessment as a multi-disciplinary activity ♦ Instruments for assessment ♦ The condensation and recording of information ♦ Making a prognosis ♦ Reviews ♦ Writing reports
Diagnosis and classification
Authors: First Michael B. , Pincus Harold Alan
Published: January 2013

In Psychiatry, as in all of medicine, diagnosis is a key function and central to developing a plan of treatment for patients. Psychiatry, however, faces special challenges. The etiopathogenesis of most psychiatric disorders is not known. For the most part, a clinician must rely on reports from, and direct observation of patients to gather the necessary information to determine a diagnosis. Until very recently, laboratory tests had little relevance. Even diagnostic information found in medical records may not be useful, since the clinician cannot ascertain whether the historically recorded diagnoses of previous clinicians were based on reliable observations, the application of similar diagnostic approaches, or even the same system of classification. These special challenges faced by the field have ensured that diagnosis and classification in psychiatry has a long and rich history.
Neuropathology
Authors: Falkai Peter , Bogerts Bernhard
Published: January 2013

The traditional domains of neuropathology are well-defined organic brain diseases with an obvious pathology, such as tumours, infections, vascular diseases, trauma, or toxic and hypoxemic changes, as well as degenerative brain diseases (e.g. Alzheimer's disease, Parkinson's disease, and Huntington's chorea). Neuropathological investigations of these brain disorders have been rewarding, because patients with any of these conditions can be expected to have gross morphological or more or less specific neurohistological anomalies related to the clinical symptoms of the disorders. Moreover, the type of brain pathology of these well-defined disease entities is quite homogenous. For example, it is highly unlikely that a patient with Parkinson's disease would not exhibit morphological changes and Lewy bodies in the nigrostriatal system, just as much a person with Huntington's chorea would have a normal striatum, or a patient with Pick'sor Alzheimer's disease would have no changes in the cerebralcortex. In contrast, the history of the neuropathology of psychiatric disorders outside primary degenerative diseases is much more controversial, because no such obvious and homogenous types of brain pathology (as seen in neurological disorders) have yet been detected for the major psychiatric illnesses such as schizophrenia, affective disorders, substance-related disorders, or personality disorders. The scope of this chapter is to summarize the neuropathological findings in schizophrenia, affective disorders, and alcoholism. Tables 2.3.5.1, 2.3.5.2, 2.3.5.3, and 2.3.5.4 highlight the significant findings. It goes beyond the scope of this chapter to review thelarge body of literature on the dementias, including specifically Alzheimer's disease. Concerning this matter, the reader is referred to several comprehensive reviews (e.g. Jellinger and Bancher 1998).
Functional positron emission tomography in psychiatry
Authors: Grasby P. M.
Published: January 2013

So far, the PET and SPET radiotracer techniques have been immediately valuable in assessing the receptor occupancy effects of antipsychotic drugs and of mapping the neural correlates of dysfunctional cognitive processes and psychiatric symptoms. Although the applications described have not yielded a diagnostic test, the techniques are undoubtedly providing unique informa-tion about the pathophysiology of psychiatric illnesses. Such information is likely to be key for the development of truly novel treatments.
Delirium
Authors: Meagher David , Trzepacz Paula
Published: January 2013

Delirium is a complex neuropsychiatric syndrome that occurs commonly across all age groups and healthcare settings. Significant adverse outcomes of delirium are increasingly recognized and can be reduced by a more consistent approach to detection that emphasizes disturbances of attention. Optimal management requires the collaborative efforts of carers and healthcare staff and judicious use of pharmacological and nonpharmacological strategies that concurrently manage underlying physical causes and the delirium itself. Greater clarity is needed regarding the prognostic relationship to dementia, phenomenology of prodromal, subsyndromal and syndromal delirium, and how risk factors, vulnerabilities, and treatment may vary across populations and treatment settings.
Vascular dementia
Authors: Erkinjuntti Timo
Published: January 2013

Vascular dementia is the second most frequent cause of dementia. Because vascular causes of cognitive impairment are common, may be preventable, and the patients could benefit from therapy, early detection, and accurate diagnosis of vascular dementia is desirable. Vascular dementia is not only multi-infarct dementia, but is related to other vascular mechanisms and pathological changes in the brain, and has other causes and clinical manifestations. Vascular dementia is not a disease, but a syndrome. The origin of this syndrome reflects complex interactions between vascular aetiologies (cerebrovascular disorders and vascular risk factors), changes in the brain (infarcts, white-matter lesions, atrophy), host factors (age, education), and cognition. Conceptual issues related to of vascular dementia include the definition of the cognitive syndrome (type, extent, and combination of impairments in different cognitive domains), and the vascular causes (vascular aetiologies and changes in the brain). Variations in these definitions has led to different estimates of point prevalence, to different groups of patients, and to reports of different types and distribution of brain lesions. The cognitive syndrome of vascular dementia is characterized by predominate executive dysfunction rather than deficits in memory and language function. Although the course of cognitive decline may be stepwise, it is often slowly progressive, and may include periods of stability or even some improvement. The relationship between vascular lesions in the brain and cognitive impairment is important, but which type, extent, side, site, and tempo of vascular lesions in the brain relates to different types of vascular dementia is not established in detail. Current criteria for vascular dementia are based on the concept of cerebral infarcts. For example the widely used NINDS-AIREN criteria include dementia, cerebrovascular disease, and a relationship between these two disorders. The main tools for the diagnosis include detailed history, neurological examination, mental state examination, relevant laboratory examinations, and preferably magnetic resonance imaging of the brain. Vascular dementia research, until recently overshadowed by that into Alzheimer's disease, is now developing rapidly. There is great promise for intervention. Developments in classification, diagnosis, and treatment are likely.
The mental health effects of cannabis use
Authors: Hall Wayne
Published: January 2013

The major adverse acute psychological effects of cannabis use are as follows: ♦ Anxiety, dysphoria, panic, and paranoia, especially in naive users ♦ Impairment of attention, memory, and psychomotor performance while intoxicated ♦ An increased risk of accident if an intoxicated person attempts to drive a vehicle. The major psychological effects of daily heavy cannabis use over many years remain contested but probably include the following: ♦ A cannabis-dependence syndrome ♦ Subtle forms of cognitive impairment that affect attention and memory and which persist while the user remains chronically intoxicated ♦ Impaired educational achievement in adolescents with a history of poor school performance, whose achievement may be limited by the cognitive impairments produced by chronic intoxication with cannabis ♦ Among those who initiate cannabis use in the early teens, a higher risk of progressing to heavy cannabis and other illicit drug use, and becoming dependent on cannabis.
Epidemiology of mood disorders
Authors: Joyce Peter R.
Published: January 2013

The Global Burden of Disease, which is a comprehensive assessment of mortality and disability from diseases and injuries in 1990 and projected to 2020, highlights the importance of mood disorders for the world. Using the measure of disability-adjusted life years, it was determined that unipolar major depression was the fourth leading cause of disease burden in the world. It was also projected that, in the year 2020, unipolar major depression would be the second leading cause of disease burden in the world. Disabilityadjusted life years is based on both mortality and disability. If one looks at disability alone, then unipolar major depression was the leading cause of disability in the world in 1990, and bipolar disorder was the sixth leading cause. Across the world, 10.7 per cent of disability can be attributed to unipolar major depression and, in developed countries, unipolar major depression contributes to nearly 20 per cent of disease burden in women aged from 15 to 44 years. This chapter addresses bipolar disorders and depressive disorders, covering diagnostic issues, prevalence, comorbidity, use of health services, and risk factors for both types of disorder.
Treatment of mood disorders
Authors: Paykel E. S. , Scott J.
Published: January 2013

This chapters looks at the evidence behind the various medication and physical treatments for mood disorders, before discussing the management options themselves, including the treatment of unipolar disorder, medication, electroconvulsive therapy, treatment of non-response and resistant depression, longer-term treatment, psychological treatments, and continuation and maintenance therapy. The treatment of bipolar disorder is also covered in detail.
Dysthymia, cyclothymia, and hyperthymia
Authors: Akiskal Hagop S.
Published: January 2013

Long before psychiatry moved to the outpatient arena in the latter part of the twentieth century, psychiatrists had observed milder mood disturbances among the kin of patients hospitalized for endogenous or psychotic depressions or mania. Some were described as sullen, morose, or otherwise moody, without discrete episodes; others reported self-limited episodes, but often went untreated. With the advent of modern treatments, practitioners are being increasingly consulted by patients presenting with attenuated affective disturbances. Although the relationship of these ambulatory mood states and more classical severe affective disorders has not been resolved, there is emerging sleep electroencephalography (EEG) and familial-genetic evidence that a continuum exists between them. Along the same lines, studies conducted in the United States and Germany into what were once described as ‘neurotic’ depressions have revealed a progression to more endogenous, psychotic, or bipolar switching. For these and related reasons, current official classification systems such as the ICD-10 and DSM-IV, have dropped the neurotic-endogenous dichotomy. Sceptics would perhaps argue that the new categorization of depressive disorders into dysthymic and major subtypes is not much of an improvement. Nonetheless, the new terminology has drawn attention to a large universe of human suffering that had been neglected in the past, and the conceptualization of dysthymia as a variant of mood disorder has had a far-reaching impact on diagnostic and therapeutic habits of clinicians worldwide. The emerging concept of the bipolar spectrum, which does include manic, cyclic depressive (bipolar II), cyclothymic, hyperthymic and related conditions, is beginning to have a similar impact on practice. The subthreshold mood disorders are not only in continuum with more pathological mood states, but they also provide a bridge with normal affective conditions. In this context, temperament, as a construct encompassing affective personalities, is currently enjoying a renaissance as one of the possible substrates for the origin of mood disorders. Temperament classically refers to an adaptive mixture of traits which, in the extreme, can lead to illness or modify the expression of superimposed affective states. The subthreshold conditions covered in this chapter represent the extreme expressions of these temperaments. A new self- administered instrument, the TEMPS-A, now validated in 10 language versions, is being used internationally to measure the classical constructs of depressive, cyclothymic, hyperthymic, and irritable, as well as anxious temperaments.
Insomnias
Authors: Espie Colin A. , Bartlett Delwyn J.
Published: January 2013

Most people's experiences of poor sleep are memorable, because sleeplessness and its daytime consequences are unpleasant. There are those, however, for whom insomnia is the norm. Persistent and severe sleep disturbance affects at least one in 10 adults and one in five older adults, thus representing a considerable public health concern. Sleep disruption is central to a number of medical and psychiatric disorders, and insomnia is usually treated by general practitioners. Therefore differential diagnosis is important, and respiratory physicians, neurologists, psychiatrists, and clinical psychologists need to be involved. The purpose of this chapter is to summarize current understanding of the insomnias, their appraisal, and treatment. Particular emphasis will be placed upon evidence-based practical management.
Parasomnias
Authors: Schenck Carlos H. , Mahowald Mark W.
Published: January 2013

Parasomnias are defined as undesirable physical and/or experiential phenomena accompanying sleep that involve skeletal muscle activity (movements, behaviours), autonomic nervous system changes, and/or emotional-perceptual events. Parasomnias can emerge during entry into sleep, within sleep, or during arousals from any stage of sleep; therefore, all of sleep carries a vulnerability for parasomnias. Parasomnias can be objectively diagnosed by means of polysomnography (i.e. the physiologic monitoring of sleep—figures 4.14.4.1, 4.14.4.2), and can be successfully treated in the majority of cases. Understanding of the parasomnias, based on polysomnographic documentation, has expanded greatly over the past two decades, as new disorders have been identified, and as known disorders have been recognized to occur more frequently, across a broader age group, and with more serious consequences than previously understood. Parasomnias demonstrate how our instinctual behaviours, such as locomotion, feeding, sex, and aggression, can be released during sleep, itself a basic instinct. There are at least eight reasons why parasomnias should be of interest and importance to psychiatrists: 1 Parasomnias can be misdiagnosed and inappropriately treated as a psychiatric disorder. 2 Parasomnias can be a direct manifestation of a psychiatric disorder, e.g. dissociative disorder, nocturnal bulimia nervosa. 3 The emergence and/or recurrence of a parasomnia can be triggered by stress. 4 Psychotropic medications can induce the initial emergence of a parasomnia, or aggravate a preexisting parasomnia. 5 Parasomnias can cause psychological distress or can induce or reactivate a psychiatric disorder in the patient or bed partner on account of repeated loss of self-control during sleep and sleep-related injuries. 6 Familiarity with the parasomnias will allow psychiatrists to be more fully aware of the various medical and neuro-logical disorders, and their therapies, that can be associated with disturbed (sleep-related) behaviour and disturbed dreaming. 7 Parasomnias present a special opportunity for interlinking animal basic science research (including parasomnia animal models) with human (sleep) behavioural disorders. 8 Parasomnias carry forensic implications, as exemplified by the newly-recognized entity of ‘Parasomnia Pseudo-suicide.’ Also, psychiatrists are often asked to render an expert opinion in medicolegal cases pertaining to sleep-related violence.
Medical conditions associated with psychiatric disorder
Authors: Rundell James R.
Published: January 2013

Seven out of 10 office visits to a primary care practitioner are related to a chronic illness. There are high levels of association of many of these chronic conditions with psychiatric disorders. Comorbid medical and psychiatric conditions increase use of medical resources and costs, as well as amplify functional impairment. For example, depression is associated with an approximately 50 per cent increase in medical costs of chronic medical illness, even after controlling for severity of physical illness. Dementia is associated with hospital costs up to 75 per cent higher than for non-demented patients. As important as a comprehensive knowledge of psychiatric diagnosis and psychosocial formulation is to a consulting psychiatrist, it is also vital to understand the pathophysiology and clinical characteristics of the medical and surgical conditions that frequently coexist with psychiatric disorders. It is also important to know the behavioural and psychiatric side effects of medications and substances. Lacking this data permits only a partial and inadequate approach to diagnosis and treatment. This section describes general medical disorders associated with psychiatric syndromes. The pathophysiology and clinical characteristics of the medical disorder are described first, followed by psychiatric syndromes often seen with that diagnosis.
The evaluation of physical treatments
Authors: Adams Clive E.
Published: January 2013

This chapter begins by describing the strengths and weakness of the single trial. It discusses the advantages and limitations of the two main approaches to the reviewing process—the traditional and the systematic. Finally the methods and the sources of systematic reviews are covered.
Rehabilitation techniques
Authors: Rössler W.
Published: January 2013

The goal of psychiatric rehabilitation is to help disabled individuals to establish the emotional, social, and intellectual skills needed to live, learn, and work in the community with the least amount of professional support. Rehabilitation practice has changed the perception of mental illness. Enabling disabled people to live a normal life in the community causes a shift away from a focus on an illness model towards a model of functional disability. As such, other outcome measures aside from clinical conditions become relevant. Social role functioning including social relationship, work, and leisure as well as quality of life and family burden are of major interest for the people affected living in the community. The relevance of psychosocial and environmental problems is reflected in the DSM-IV and ICD-10. Axis IV of DSM-IV and codes Z55–Z65 and Z73 of ICD-10 are assigned for reporting psychosocial and environmental problems that may affect the diagnosis, treatment, and prognosis of mental disorders.
Delirium in the elderly
Authors: Lindesay James
Published: January 2013

Although delirium occurs at all ages, it is most frequently encountered in late life. This is because delirium is the result of an interaction between individual vulnerability factors (e.g. brain disease, sensory impairment) and external insults (e.g. physical illness, medication), the rates of which both increase with age. Our current concept of delirium derives principally from the florid clinical stereotype that has evolved from centuries of clinical observations on younger patients, and it may not be applicable to our historically unique ageing population. In younger adults, a major physical insult is usually necessary to precipitate delirium, which is often a dramatic disturbance. This is not the case in vulnerable elderly patients when relatively mild physical, psychological, or environmental upsets may be sufficient to bring about acute disturbances of mental functioning. These disturbances may be less obvious than in younger patients, particularly if they occur in the context of pre-existing cognitive impairment. Consequently, despite being common and problematic, delirium in elderly patients is frequently missed or misdiagnosed as dementia or depression by medical and nursing staff. This is unfortunate, because delirium is an important non-specific sign of physical illness or intoxication, and if left untreated there may be costly consequences, both for the patient and for health services.
Mood disorders in the elderly
Authors: Baldwin Robert
Published: January 2013

This chapter considers some of the commonly asked questions about mood disorders in later life. Is depression in later life a distinct clinical syndrome? How common is it? Is there an organic link, for example to cerebral changes, and if so, is there an increased risk of later dementia? Is it more difficult to diagnose and treat late-life depression, and once treated, is the outcome good, bad, or indifferent? The emphasis will be on depression but bipolar disorder and mania will also be considered.
Gender identity disorder in children and adolescents
Authors: Green Richard
Published: January 2013

Psychosexual development of sex-typed behaviours spans a broad mix of the elements that comprise ‘masculinity’ and ‘femininity’. The possibility for variation is extensive. Among males, there are boys and men whose stereotypical masculinity may pose problems in mental health and criminality. They are not the focus here. Rather, here it is the marked deviation from the mean towards the ‘non-masculine’ or ‘feminine’ extreme. That pattern can also cause clinical concern and constitutes gender identity disorder (GID) as manifested in childhood. For females, conventional ‘tomboyism’ is not the focus here, but rather the extreme that can cause clinical concern and constitutes GID.
Effects of parental psychiatric and physical illness on child development
Authors: Ramchandani Paul , Stein Alan , Murray Lynne
Published: January 2013

A broad range of physical and psychiatric illnesses commonly affect adults of parenting age. For example, approximately 13 per cent of women are affected by depression in the postnatal period, and the prevalence of depression in parents of all ages remains high. Many parents will also experience severe physical illness; breast cancer affects approximately 1 in 12 women in the United Kingdom, about a third of whom have children of school age. Worldwide HIV has an enormous impact on adults of parenting age. In some parts of sub-Saharan Africa up to 40 per cent of women attending antenatal clinics are HIV positive. Many of these parental disorders are associated with an increased risk of adverse emotional and social development in their children, and in some cases cognitive development and physical health are also compromized. It must be emphasized that a significant proportion of children at high risk do not develop problems and demonstrate resilience, and, many parents manage to rear their children well despite their own illness. Nonetheless these risks represent a significant additional impact and burden of adult disease (both physical and psychiatric) that is often overlooked. This chapter reviews the current state of evidence regarding selected examples of psychiatric and physical conditions, from which general themes can be extracted to guide clinical practice. Some of the key mechanisms whereby childhood disturbance does or does not develop in conjunction with parental illness are considered, and strategies for management and intervention reviewed.
The effects of bereavement in childhood
Authors: Black Dora , Trickey David
Published: January 2013

Bereavement in childhood, particularly the loss of a parent, represents a significant adversity, although the majority of bereaved children do not develop anything other than transient symptoms. Nevertheless, there is evidence that a brief preventive intervention can reduce subsequent morbidity. Children, who lose a parent through suicide, homicide, accident, or disaster, especially if they have witnessed the death, are at high risk of developing post-traumatic stress disorder and other psychiatric disorders and their treatment needs should be assessed by mental health professionals.
Epilepsy and epilepsy-related behaviour disorders among people with intellectual disability
Authors: Iivanainen Matti
Published: January 2013

Epilepsy is defined as at least one epileptic seizure; this in practice means two or more epileptic seizures unprovoked by any immediate identifiable cause during a relatively short period of time. Epileptic seizure is a clinical manifestation presumed to result from an abnormal and excessive discharge of a set of neurones in the brain. An epileptic syndrome is a cluster of symptoms and signs including type of seizure, mode of seizure recurrence, neurological findings, and neuroradiological or other findings of special investigations, customarily occurring together. An epileptic syndrome can have more than one cause or the cause may remain unknown; consequently outcomes may be different. Pseudoseizure is used to denote epilepsy-like seizures without concomitant EEG changes. Epilepsy and intellectual disability are symptoms of brain origin. The former is an unstable condition, where during the seizure or ictally the behaviour of a person with epilepsy is abnormal, but between the seizures or interictally there is no affect of epilepsy on his or her behaviour. Intellectual disability is a more or less stable condition. However, the categories of the degrees of intellectual disability are neither absolute nor static, as some children may move up or down between them. This chapter deals with the diagnosis, manifestations, behavioural disorders, frequency, aetiology, treatment, effects of antiepileptic drugs on behaviour, and prognosis of epilepsy in people with intellectual disability.
Methods of treatment
Authors: Berney T. P.
Published: January 2013

There are a large number and variety of treatments for any disorder in intellectual disability: a good indication of the complexity of disturbance and the inconsistency of the effectiveness of any one treatment. Therapists have an unusual responsibility not to exploit the limited ability of their patients to withhold consent as well as to try to see the world through their eyes. They have also to combine simultaneously the enthusiasm of the charismatic healer with the objectivity and scepticism of the scientist. As in any experiment, changes in treatment should be introduced singly to ensure that it is clear which manoeuvre produces which result. However, treatments complement each other and should not be used in isolation. This is the area above all in which the patient depends on teamwork and cooperation between therapists, disciplines, and agencies.
Palliative Social Work: An Historical Perspective
Authors: Harper Bernice Catherine
Published: January 2013

This textbook on palliative social work is a companion volume to the Oxford Textbook of Palliative Medicine and the Oxford Textbook of Palliative Nursing. To that end, this chapter will accomplish the following:
Key Roles for Palliative Social Work in Correctional Settings
Authors: Linder John F. , Enders Sheila R.
Published: January 2013

This textbook on palliative social work is a companion volume to the Oxford Textbook of Palliative Medicine and the Oxford Textbook of Palliative Nursing. To that end, this chapter will accomplish the following:
Sexuality, Sensuality, and Intimacy in Palliative Care
Authors: Gallo-Silver Les
Published: January 2013

This textbook on palliative social work is a companion volume to the Oxford Textbook of Palliative Medicine and the Oxford Textbook of Palliative Nursing. To that end, this chapter will accomplish the following:
The Social Work Role in Pain and Symptom Management
Authors: Cagle John G. , Altilio Terry
Published: January 2013

This textbook on palliative social work is a companion volume to the Oxford Textbook of Palliative Medicine and the Oxford Textbook of Palliative Nursing. To that end, this chapter will accomplish the following:
Bereavement in the Beginning Phase of Life: Grief in Children and Their Families
Authors: Cincotta Nancy F.
Published: January 2013

This textbook on palliative social work is a companion volume to the Oxford Textbook of Palliative Medicine and the Oxford Textbook of Palliative Nursing. To that end, this chapter will accomplish the following:
Social Work and Nursing: Creating Effective Collaborations in Palliative Care
Authors: Holly Nelson-Becker , Ferrell Betty R.
Published: January 2013

This textbook on palliative social work is a companion volume to the Oxford Textbook of Palliative Medicine and the Oxford Textbook of Palliative Nursing. To that end, this chapter will accomplish the following:
The Social Work Role in Decision Making: Ethical, Psychosocial, and Cultural Perspectives
Authors: Borgmeyer Tracy
Published: January 2013

This textbook on palliative social work is a companion volume to the Oxford Textbook of Palliative Medicine and the Oxford Textbook of Palliative Nursing. To that end, this chapter will accomplish the following:
Novel mutations in Marburg virus glycoprotein associated with viral evasion from antibody mediated immune pressure
Authors: Kajihara Masahiro , Nakayama Eri , Marzi Andrea , Igarashi Manabu , Feldmann Heinz , Takada Ayato
Published: January 2013

Marburg virus (MARV) and Ebola virus, members of the family Filoviridae, cause lethal haemorrhagic fever in humans and non-human primates. Although the outbreaks are concentrated mainly in Central Africa, these viruses are potential agents of imported infectious diseases and bioterrorism in non-African countries. Recent studies demonstrated that non-human primates passively immunized with virus-specific antibodies were successfully protected against fatal filovirus infection, highlighting the important role of antibodies in protective immunity for this disease. However, the mechanisms underlying potential evasion from antibody mediated immune pressure are not well understood. To analyse possible mutations involved in immune evasion in the MARV envelope glycoprotein (GP) which is the major target of protective antibodies, we selected escape mutants of recombinant vesicular stomatitis virus (rVSV) expressing MARV GP (rVSVΔG/MARVGP) by using two GP-specific mAbs, AGP127-8 and MGP72-17, which have been previously shown to inhibit MARV budding. Interestingly, several rVSVΔG/MARVGP variants escaping from the mAb pressure-acquired amino acid substitutions in the furin-cleavage site rather than in the mAb-specific epitopes, suggesting that these epitopes are recessed, not exposed on the uncleaved GP molecule, and therefore inaccessible to the mAbs. More surprisingly, some variants escaping mAb MGP72-17 lacked a large proportion of the mucin-like region of GP, indicating that these mutants efficiently escaped the selective pressure by deleting the mucin-like region including the mAb-specific epitope. Our data demonstrate that MARV GP possesses the potential to evade antibody mediated immune pressure due to extraordinary structural flexibility and variability.
Technologies for Extraction and Production of Bioactive Compounds to be Used as Nutraceuticals and Food Ingredients: An Overview
Authors: Joana Gil‐Chávez G. , Villa José A. , Fernando Ayala‐Zavala J. , Basilio Heredia J. , Sepulveda David , Yahia Elhadi M. , González‐Aguilar Gustavo A.
Published: January 2013

Natural bioactive compounds include a broad diversity of structures and functionalities that provide an excellent pool of molecules for the production of nutraceuticals, functional foods, and food additives. Some of those compounds can be found in nature at high concentration such as polyphenols but others can only be found at very low levels, so that massive harvesting is needed to obtain sufficient amounts, and their structural diversity and complexity make chemical synthesis unprofitable. The inherent difficulties in screening and producing these compounds have led to the development of advanced technologies. The commonly used methods for their extraction are the conventional liquid–liquid or solid–liquid extraction and the advanced include pressurized‐liquid extraction, subcritical and supercritical extractions, and microwave‐ and ultrasound‐assisted extractions. In addition, these extraction techniques have been improved with previous steps (enzyme‐and instant controlled pressure drop‐assisted extractions) which help to release the compounds from the matrix. These technologies could provide in the next few years an innovative approach to increase the production of specific compounds for use as nutraceuticals or as ingredients in the design of functional foods.
Mutuality in the management of human resources: assessing the quality of alignment in employment relationships
Authors: Boxall Peter
Published: January 2013

How can managers improve the alignment of organisational and individual interests in the management of human resources? This article integrates a diverse set of literatures to propose three tests of mutuality in employment relationships: (a) the quality of the match between the organisation's needs for human capabilities and the individual's needs to deploy and develop them; (b) the extent to which the organisation's dual needs for commitment and flexibility are aligned with the needs of individuals for security and community; and (c) the extent to which both parties feel they are making a worthwhile return on their investment. These tests form a starting point for assessing and modelling the quality of employment relationships in particular contexts.
Bone‐healing pattern at the surface of titanium implants: an experimental study in the dog
Authors: Rossi Fabio , Lang Niklaus P. , De Santis Enzo , Morelli Fabrizio , Favero Giovanni , Botticelli Daniele
Published: January 2013

Objective

To study the early sequential stages of osseointegration at implants installed in alveolar bony.

Materials and methods

In 12 Labrador dogs, all mandibular premolars and first molars were extracted bilaterally. After 3 months of healing, full‐thickness flaps were elevated in the edentulous region of the right side of the mandible. Implants were installed, and the flaps were sutured to allow a fully submerged healing. The timing of the installations in the left side of the mandible and of sacrifices were performed with a schedule that various observation periods to sacrifice from 5, 10, 20, and 30 days were available so thatn = 6 was obtained per each healing period. Ground sections were prepared and analyzed.

Results

Newly formed bone in contact with the implant surface was found after 10 days of healing and the percentage increased up to 50% after 1 month of healing. A higher percentage was found in the trabecular compared with the cortical bony compartment. Old bone decreased by about 50% during healing, being still present after 1 month (16%). The proportions of bone debris and bone particles were at 27% after 5 days and decreased during healing to 6% after 1 month.

Conclusion

Osseointegration (new bone‐to‐implant contact) developed at various rates for cortical and trabecular compartments, respectively. In the trabecular region, mesenchymal cells were identified, subsequently developing into new bone in contact with the implant surface. In the cortical compartment, however, resorptive processes were observed throughout all periods of healing. The proportion of newly formed bone percentage was lower compared with that of the trabecular area. Old bone was still present after 1 month of healing in both compartments. Bone debris and small bone particles appeared to be involved in initial bone formation.