bluuebunny/crossref_metadata_2025 huggingface dataset:
Support Groups and Behavioral Science
Authors: Rummell Christina M.
Published: June 2018

While a psychological evaluation is often a required part of a weight-loss surgery workup, providers are becoming aware of the need for behavioral health services during each phase of the surgery process. Research has documented a higher prevalence of psychiatric comorbidities in severely obese patient populations, with those who receive behavioral health interventions before surgery having better outcomes than those who do not. Common recommendations and interventions for pre- and postoperative behavioral health optimization are reviewed and discussed.

Statistics indicate a greater lifetime prevalence of substance use disorders in weight-loss surgery patients than in the general population. Postoperative complications have been shown to result from substance abuse, making it one of the top-cited contraindications for surgery. Preliminary recommendations for assessing and addressing substance use in bariatric surgery candidates are discussed.
Online Preoperative Risk Assessment Tools
Authors: Aminian Ali
Published: June 2018

Despite the presence of robust data on safety and efficacy of bariatric and metabolic surgery, many patients and physicians do not consider surgery to treat obesity, diabetes, and metabolic syndrome. One reason may be inaccurate beliefs about the risk-benefit ratios of medical and surgical treatments of obesity. Estimating the risk of postoperative complications can improve surgical decision-making and informed patient consent. Furthermore, there would be a considerable benefit in identifying modifiable preoperative conditions that are associated with increased risk of postoperative adverse events. The methodology and characteristics of online risk assessment tools in bariatric surgery are presented in this chapter.
Bariatric Surgery and Perioperative Infections
Authors: Alsulaimy Mohammad , Motamedi Seyed Mohammad Kalantar
Published: June 2018

Morbid obesity is associated with an increased risk of infectious complications including surgical site, urinary tract, and pulmonary infections. Surgical site infections (SSI) are the most common, followed by urinary and respiratory infections. Various risk factors in obese patients including impaired immunity, and altered pulmonary and circulatory systems contribute to the increased susceptibility of morbid obese patients to infectious complications. Perioperative infections are defined to occur within 30 days of the initial operative procedure. Surgical site and urinary tract infections usually occur within 7–10 days post-operatively. Therefore, it is recommended that patients should be followed up between 7 to 10 days post-op to examine surgical sites, and to screen for possible urinary tract symptoms. This chapter will discuss the diagnosis, treatment, and possible preventative measures of the aforementioned infectious complications in the bariatric surgery population.
Thromboembolic Complications after Bariatric Surgery
Authors: Menon Ashok , Lavryk Olga , Khwaja Haris A. , Bartholomew John R. , Hanipah Zubaidah Nor
Published: June 2018

Venous thromboembolism (VTE) is a major cause of early death after bariatric surgery, even in the laparoscopic era, accounting for up to a third of early deaths. While risk factors associated with the development of postoperative VTE in nonbariatric surgery are relevant in bariatric patients, it is now clear that both obesity and obesity-related diseases, such as obesity hypoventilation syndrome, pose an additional risk. Attempts have been made to standardize VTE prophylaxis for patients undergoing bariatric surgery, and early ambulation, mechanical compression devices, chemoprophylaxis, and inferior vena cava filters have all been studied extensively. However, the relative lack of high-quality evidence from randomized trials means that a consensus about what constitutes an ideal VTE prophylaxis regime has not yet been achieved.
Biliary Complications of Bariatric Surgery
Authors: Corcelles Ricard , Ponsky Jeffrey L.
Published: June 2018

Obesity is a major public health problem associated with significant morbidity and mortality. Obesity is also a well-known risk factor for gallstone formation. Bariatric surgery is the most effective therapy for morbid obesity; however, the metabolic alterations it imparts can cause specific mid- or long-term complications, such as biliary lithiasis. The rate of development of cholelithiasis after bariatric surgery has been reported to be around 32% to 42% with studies ranging from 2–52% depending on use of pharmacologic prophylaxis. Therefore, prophylactic cholecystectomy during gastric bypass was historically recommended in the era of open surgery. The current management of gallbladder pathology remains a point of contention, ranging from prophylactic cholecystectomy, to cholecystectomy in the setting of biliary symptoms or presence of stones on preoperative ultrasound, to expectant management. This chapter discusses the current evidence regarding biliary complications and management in bariatric surgery.
Complications and Challenges of Bariatric Surgery in Super-Obese Patients
Authors: Eldar Shai Meron , Eldar Ofer
Published: June 2018

While the lower weight limits for bariatric surgery are already strictly set, the upper weight limits are still undetermined. The extremely obese patient deserves special consideration: significant comorbidities, technical difficulties, and increased postoperative morbidity and mortality are all expected in this patient population.

In view of these factors, how should super-obese patients (BMI > 50 kg/m2) be approached, and is there any preferred procedure? Is there a point where operative risk outweighs surgical benefits? Bariatric surgery for super-obese and super-super-obese patients, including the operative complications and the associated morbidity and mortality, as well as the way they influence the approach to this subgroup of patients, are the subjects of this chapter.
Obstructive Sleep Apnea
Authors: Rogula Tomasz G. , Martin Adriana , Mejia Ivan Alberto Zepeda
Published: June 2018

Obstructive sleep apnea (OSA) is highly prevalent in morbidly obese patients, although it is surprisingly underdiagnosed and undertreated. OSA can increase the risk of serious and life-threating complications in the perioperative period of bariatric surgery. Nevertheless, this potential risk can be minimized with adequate preoperative screening and perioperative management. The perioperative management of patients with OSA will affect the preparation for surgery, airway management, anesthetic selection, and monitoring. This chapter discusses and presents the best evidences available for the management of patients with OSA in order to decrease both the prevalence of undiagnosed patients and the morbidity associated with bariatric surgery.
Acute Kidney Injury after Bariatric Surgery
Authors: Sivan Shobana , Navaneethan Sankar D.
Published: June 2018

Bariatric surgery is an effective and durable treatment option for weight loss and remission of diabetes in obesity. Incidence of acute kidney injury (AKI) after bariatric surgery has ranged between 2.8% and 8.5%, depending on the definition used in the studies. Published reports have used serum creatinine alone in determining the incidence of AKI and thereby have underestimated AKI prevalence. AKI has prognostic significance among bariatric surgery patients and is associated with increased healthcare utilization and increased mortality in patients with AKI when compared to patients who do not sustain AKI after bariatric surgery. AKI management in bariatric surgical patients is often similar to management in other postoperative patients, involving optimal volume management, avoidance of nephrotoxic agents, including contrast, and supportive care. Early involvement of nephrologists is helpful in instituting appropriate care for these patients.
Safety and Efficacy of Bariatric Surgery in Patients with Cirrhosis
Authors: Shimizu Hideharu , Rogula Tomasz G. , Schauer Philip R.
Published: June 2018

Perioperative risks for morbidly obese patients with cirrhosis are significant, and surgeons should consider these risks carefully in deciding on the type of bariatric procedure to be performed. The benefits of bariatric surgery for cirrhotic patients include substantial weight loss, improvements in metabolic diseases, and potential regression of fibrosis, which can also increase their eligibility and candidacy for liver transplantation. There is currently a lack of strong evidence, but the restrictive bariatric procedures are the safest options for carefully selected patients with cirrhosis. Sleeve gastrectomy is likely the best bariatric procedure for obtaining good outcomes without a prohibitive complication rate or mortality for patients with compensated, Child-Pugh class A cirrhosis without portal hypertension. Roux-en-Y gastric bypass is also appropriate for patients who are not suitable for sleeve gastrectomy. Surgeons should be prepared in case they see bariatric patients with cirrhosis diagnosed preoperatively or intraoperatively.
Revisional Bariatric Surgery
Authors: Frenkel Catherine , Pryor Aurora
Published: June 2018

The annual volume of bariatric surgery is growing, giving rise to an increase in complications requiring complex management, including revision. Bariatric revision procedures are also becoming increasingly necessary for weight-loss recidivism and patients at the extreme of obesity. This chapter outlines clinical management pathways used to address secondary bariatric surgery. It summarizes reasons for, and outcomes with, revision of a laparoscopic gastric band, vertical banded gastroplasty, sleeve gastrectomy, or Roux-en-Y gastric bypass. Surgical techniques used to manage weight regain or failed weight loss after bariatric surgery are also discussed. Finally, surgical solutions for bariatric surgery-induced malnutrition are described, particularly in the setting of biliopancreatic diversion, duodenal switch, or jejunoileal bypass. Overall, the chapter concludes that standardization of revisional procedures can have a significant patient impact, and guidelines must be evidence-based in order to ensure patient safety and success.
Management of Laparoscopic Sleeve Gastrectomy
Authors: Ordoñez Alex , Lo Menzo Emanuele , Szomstein Samuel , Rosenthal Raul J.
Published: June 2018

The increased popularity of laparoscopic sleeve gastrectomy (LSG) can be attributed to its technical simplicity, coupled with its good results. Strictures after LSG are reported with a low incidence. The reasons for strictures are mostly mechanical and are related to the size of the bougie utilized, the proximity of the stapler to the bougie, and twisting of the stapler along the longitudinal axis. Mild cases of strictures immediately postoperatively are typically the result of temporary edema and can be managed expectantly. Strictures that do not resolve quickly with time or that present later on will likely need endoscopic intervention or even reoperation. Among the surgical interventions, sleeve seromyotomy has been reported to have success; however, in refractory cases, the conversion to Roux-en-Y gastric bypass is necessary.
Prevention and Management of Complications in Biliopancreatic Diversion with Duodenal Switch
Authors: Biertho Laurent , Robert Maud , Marceau Picard
Published: June 2018

This chapter summarizes the early postoperative and long-term complications of biliopancreatic diversion with duodenal switch (BPD-DS) procedures. Perioperative mortality for BPD-DS is currently around 0.1%, with an early complication rate of 7%. The standard follow-up required for the prevention of nutritional deficiencies as well as the management of short- and long-term complications specific to metabolic surgeries are also discussed. The data and clinical views expressed in this chapter are based to a large extent on the authors’ experience with 5,000 BPD-DS surgeries in our institution over the last 25 years, and which have been reported extensively in the literature. In our experience, severe protein malnutrition occurred in 10% patients, of whom 5% required readmission and 1.5% a surgical revision to correct the problem.
Vertical Banded Gastroplasty
Authors: Ver Maria R. , Fouse Tammy S.
Published: June 2018

Vertical banded gastroplasty (VBG) is the construction of a small vertical pouch using a linear stapler, with addition of a Marlex band placed through a window formed by a circular stapler. Compared to gastric bypass, VBG maintains a more normal anatomy of the upper gastrointestinal tract. However, due to poor long-term outcomes and a high percentage of patients requiring revisional surgery, most bariatric surgeons have abandoned VBG as a primary bariatric procedure. Early complications include acute gastric distention and gastric leaks. Late complications include mesh migration or erosion, stomal stenosis, staple-line disruption, and gastrogastric fistulas. The most common revision is to Roux-en-Y gastric bypass (RYGB). There are reports of other revisions, such as the vertical banded gastroplasty−gastric bypass (VBG-GB), re-VBG, RYGB-on-VBG, VBG to duodenal switch, VBG to biliopancreatic diversion, VBG to sleeve gastrectomy, VBG to adjustable gastric band, and VBG reversal, as well as endoscopic alternatives.
Single-Anastomosis Malabsorptive Procedures
Authors: Rancaño Rocío Santos , Pernaute Andrés Sánchez , Garcia Antonio José Torres
Published: June 2018

Malabsorptive interventions are recognized as the procedure of choice in metabolic surgery and as the best strategy for re-do surgery when restriction fails. This chapter describes the most recently published single-anastomosis malabsorptive procedures: the one-anastomosis gastric bypass (OAGB), the single-anastomosis duodenoileal anastomosis with sleeve (SADIS), the duodenojejunal omega switch (DJOS), the duodenoileal omega switch (DIOS), the ileal food diversion (IFD), and the sleeve gastrectomy with loop bipartition (SG + LB). These procedures are effective and safe and may be regarded as an option, although no consensus exists as to which procedure offers the best option overall, nor is there an established criterion or algorithm for a made-to-measure procedure for a given patient. The use of a single anastomosis is the most important part of the techniques. All the procedures are relatively new and their safety should be evaluated in bigger randomized trials.
General Approach to Pregnancy Care in the Neurologic Patient
Authors: Lynch Tara A. , Thornburg Loralei L.
Published: June 2018

Caring for the obstetric patient with significant medical problems can be complex. Neurologic diseases in pregnancy can range in severity and therefore vary in the amount of care planning that is required. Certain diseases will require more coordination of care with multidisciplinary teams than others. In these cases, the use of care maps or guidelines can assist practitioners with providing comprehensive care. This chapter will serve as an overview of pregnancy-specific considerations that will be reviewed in subsequent chapters throughout this book. Overall, by focusing attention to the specific needs of the complex obstetric neurologic patient, practitioners can help to optimize outcomes for these women and their pregnancies.
Pregnancy Safety and Termination
Authors: Whaley Natalie S. , Evans Adam
Published: June 2018

Access to compassionate, nonjudgmental, and safe abortion care for medically complex women is an important component of obstetric care for high-risk women. The care of women with neurologic disease who seek pregnancy termination or management of pregnancy failure includes consideration of their particular medical, anesthesia, and surgical needs. Counseling regarding pregnancy options is an important first step in helping women achieve their family planning goals. Understanding the safety of abortion, as well as options for medical, surgical, or labor induction termination can help providers discuss pregnancy options with women. Resources are available to help non-obstetric providers ensure their patients have access to medically sound, evidence-based information about pregnancy termination.
Prenatal Genetics for Women with Neurology Disease
Authors: Dukhovny Stephanie
Published: June 2018

The genetic evaluation of heritability of genetic disease, as well as screening of the fetus for neurologic diseases, have evolved a great deal since the 1970s. Screening and diagnostic evaluation now includes the ability to detect fetuses with anatomic abnormalities of the central nervous system and rare autosomal recessive disorders with neurologic features. Preimplantation genetic diagnosis now allows families with confirmed genetic abnormalities to utilize in vitro fertilization technologies to avoid affected pregnancies. For families that have not received a prenatal diagnosis, newborn screening allows for detection of diseases with potential neurologic implications in the child’s early newborn period.
Immune-mediated Disorders of the Central Nervous System
Authors: Coyle Patricia K.
Published: June 2018

This chapter reviews pregnancy in multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and acute transverse myelitis (ATM) syndrome. MS is a major acquired disease of young adults, with a rising female predominance. MS has no direct negative consequences on fertility or pregnancy. Pregnancy has a profound effect on MS, with decrease in disease activity during the last trimester counteracted by a three-month postpartum increase in disease activity. With the development of disease-modifying therapies, important questions arise about washout periods, the feasibility and risks of treating during pregnancy and breastfeeding, and the potential of treatment-related adverse fetal effects. Fortunately, there is good information to counsel women with MS. Neuromyelitis Optica Spectrum Disorder (NMOSD) is a neuroimmune channelopathy. It is a distinct disorder from MS. NMOSD disease activity is not favorably affected by pregnancy. The postpartum period has real risk for disabling attacks. This influences recommendations about breastfeeding and how quickly to resume therapy postpartum. Acute transverse myelitis (ATM) syndrome can occur in both MS and NMOSD but can also be due to other disorders. Workup and treatment of ATM during pregnancy is reviewed, as well as implications for delivery.
Headache
Authors: Friedman Deborah I. , Masrour Shamin , Hutchinson Susan
Published: June 2018

In most cases, women with headache disorders have normal pregnancy and delivery outcomes and should not be discouraged from becoming pregnant. Pre-pregnancy planning includes weaning of contraindicated medications. Most women with migraine without aura improve during pregnancy. Although there are limitations, various acute and preventive treatments may be employed, including non-pharmacologic options. Anti-epileptic medications should be avoided. For pseudotumor cerebri, the mainstay of treatment includes diuretics and therapeutic lumbar punctures, avoiding topiramate. Surgical treatment may be necessary if vision is threatened. Close monitoring and collaboration between an ophthalmologist, neurologist and obstetrician are critical. New-onset pseudotumor cerebri requires an investigation for secondary causes such as cerebral venous thrombosis. In the absence of a pre-existing primary headache disorder, new headaches in the postnatal period warrant evaluation for secondary headache disorders, including post-dural puncture headache, stroke, cerebral venous thrombosis, pre-eclampsia, eclampsia, reversible cerebral vasoconstriction syndrome (RCVS), and pituitary apoplexy.
Cerebral Venous Thrombosis
Authors: Pichler Michael R. , Brown Robert D.
Published: June 2018

Thrombosis of cortical veins and/or dural venous sinuses (CVT) is a rare but potentially devastating condition. CVT is more common in women and is strongly associated with pregnancy and the postpartum period, likely due to numerous procoagulant changes during this time. CVT can cause a wide range of symptoms depending on location of thrombosis. Clinical manifestations can include headache, cranial nerve deficits, seizures, and venous infarction with associated focal neurologic deficits. Severe cases may progress to coma and death, emphasizing the importance of early diagnosis and treatment. The approach to management of CVT during pregnancy and the postpartum period must be tailored to prevent complications to the mother and child. This chapter addresses the pathogenesis, clinical manifestations, diagnosis, and treatment of CVT in pregnancy and the postpartum period.
Postpartum Care for Women with Epilepsy
Authors: Fountaine Elizabeth , Rogers Patricia , Liu Lynn
Published: June 2018

A majority of women with epilepsy (WWE) will have a normal pregnancy and labor course. The postpartum period is a high risk time for WWE, which is less commonly addressed and arguable more important to discuss and plan for. The best way to have an uneventful labor and postpartum course is to make a care map before a WWE becomes pregnant. Providers should plan comprehensive epilepsy treatment not only during a pregnancy but also for the postpartum period including anticipated changes in AED dosing, breastfeeding discussions, and anticipation of the importance of social support. This includes providing ideas and suggestions to WWE about how to best care for themselves and keep their infant safe in the setting of a possible seizure. This chapter will discuss some of the challenges WWE face in the postpartum period and necessary considerations to ensure a safe and healthy transition to parenthood.
Sleep Disorders and Pregnancy
Authors: Liu Lynn
Published: June 2018

Pregnant women frequently have sleep concerns. Some concerns are related to the course of the pregnancy, some sleep disorders change during pregnancy, and others develop new onset sleep disorders during pregnancy. Having a sleep medicine professional to assist in the management of a pregnant woman to address the treatment of particular sleep disorders can be helpful in alleviating specific concerns over the course of the pregnancy. Anticipating potential interactions or how the pregnancy and the sleep disorder may affect each other may improve maternal and fetal outcomes. This chapter will review common sleep disorders that can be encountered in pregnant women.
Neuromuscular Diseases
Authors: Hamel Johanna , Ciafaloni Emma
Published: June 2018

Myasthenia gravis is an acquired autoimmune disorder characterized by weakness of skeletal muscle, which often affects women in the childbearing age. A number of questions arise when a woman with myasthenia gravis plans to become pregnant or presents with pregnancy, as myasthenia can affect the pregnancy, delivery and the fetus. In addition, the pregnancy can affect the course of myasthenia and worsening of the disease during pregnancy may require treatment modifications. Therefore supportive counseling, ideally preceding conception, is indicated, focusing on issues of fertility, treatment optimization and drug safety, risks of worsening of symptoms during pregnancy and delivery. Counseling on possible effects on the infant should be discussed, as such as neonatal myasthenia gravis, a treatable and transient disease. Patients with myasthenia gravis may require more intensive monitoring and care, and should be supported by a multidisciplinary team involving the obstetrician, anesthesiologist, and neurologist.
Development of the concept
Authors: Taylor Eric
Published: June 2018

Over time, concepts have evolved from the idea of a constitutional basis for behavioural problems, through unitary neurological formulations, to the recognition of neurocognitive heterogeneity and the impact of the social environment. Diagnoses have altered accordingly. ADHD and hyperkinetic disorder have different historical traditions, and still generate international differences in practice; however, they have succeeded in keeping research and clinical practice in touch with each other. This chapter takes a historical approach to describe the influences on the development of the concepts. Concepts are still changing, in response both to the historical context and to improving scientific knowledge. It may well be that recognition of heterogeneity at neural, psychological, and genetic levels will lead to more and better differentiated behavioural concepts. For the moment, however, the clinical utility of diagnosis based on observable behaviour is likely to maintain ADHD as the dominant idea organizing the field.
Conceptualizing and investigating the role of the environment in ADHD
Authors: Sonuga-Barke Edmund , Harold Gordon
Published: June 2018

This chapter provides a conceptual framework for scientists and practitioners to think systematically about the role of the environment vis-à-vis ADHD. This chapter distinguishes the environment as cause(s) of ADHD relative to its role in defining its clinical and behavioural expression and its use in treatment. The aim of the chapter is not to review in comprehensive detail the evidence relating to the role of the environment in relation to ADHD with regard to these different elements—although illustrations of the value of each conceptualization of environment will be presented—but to highlight the way in which environments influence and are influenced by ADHD.
Insights from neuroanatomical imaging into ADHD throughout the lifespan
Authors: Shaw Philip , Szekely Eszter
Published: June 2018

The relatively recent advent of magnetic resonance imaging has given us an invaluable ‘window’ into the brain in ADHD. Here we review the literature on the structural neuroimaging of ADHD throughout the lifespan. Meta-analyses and large individual studies converge to find anomalies in the basal ganglia in ADHD; some appear developmentally stable, while others are progressive. Compromise of the cerebral cortex and cerebellum are also commonly reported, and developmental trajectories of these structures have been linked with the highly variable clinical course of the disorder. ADHD can be considered dimensionally, lying at the extreme end of a continuous distribution of symptoms and underlying cognitive processes. Some studies find such dimensionality is also present in ADHD-related neuroanatomical change. Pilot studies have examined how variation in some candidate genes is tied to neuroanatomy in the disorder. Studies at the level of the entire genome await much larger cohorts.
Neuropsychological functioning and ADHD
Authors: O’Neill Sarah , Halperin Jeffrey M. , Coghill David
Published: June 2018

The high prevalence of ADHD and its associated difficulties in adaptive functioning have led to significant efforts to better understand the underlying pathophysiology of the disorder. Prominent models of ADHD have suggested that neurocognitive deficits—particularly executive dysfunction—is directly related to ADHD symptomatology. Data suggests, however, that significant heterogeneity is observed in both the cognitive and adaptive functioning of individuals with ADHD, raising questions about current theoretical models. Furthermore, many of our current models do not explain the developmental trajectory of ADHD symptoms and impairment. This chapter will explore the state of the literature and remaining questions that are driving research on the role of neuropsychological functioning in ADHD, approaching the topic from a developmental perspective. We will conclude by considering implications of this knowledge for the development of effective and long-lasting interventions for individuals with ADHD.
Epidemiology
Authors: Polanczyk Guilherme V.
Published: June 2018

This chapter initially reviews the main methodological aspects of ADHD prevalence studies, specifically study design, case definition, and ascertainment to subsequently address meta-analyses summarizing the prevalence of the disorder on children, adolescents, and adults. Results of meta-regression in the context of meta-analysis have investigated the effect of year of publication, sample location, and methodological characteristics of studies on heterogeneity of results. Studies on the course of the disorder, following up clinical and community samples, are discussed, as well as cultural influences on epidemiological findings. Large-scale cross-national studies and longitudinal studies following non-referred samples are necessary to further advance the knowledge on the epidemiology of ADHD.
Sex differences in ADHD
Authors: Greven Corina U. , Richards Jennifer S. , Buitelaar Jan K.
Published: June 2018

This chapter reviews sex differences in ADHD, focusing on differences in prevalence, comorbidity, and impairment, and discusses potential mechanisms underlying these differences. ADHD is more common in males than females (sex ratio ~3:1). Males with ADHD show greater comorbidity with comorbid externalizing (conduct) problems, while females with ADHD show internalizing problems. Females with ADHD may experience greater subjective impairment than males with ADHD. Referral and diagnostic issues, relating to sex-specific display of ADHD symptoms (more overt and disruptive in males, more subtle in females), underdiagnosis, or misdiagnosis in girls, as well as biases due to informant source, likely contribute to sex differences in ADHD. Potential biological mechanisms include endocrine factors (testosterone, glucocorticoids, and hypothalamic–pituitary–adrenal axis activation differences), aetiological sex differences (sex-chromosome genes), sex differences in neurocognitive functioning, and differences in brain structure and function. The chapter provides an outlook for future research and clinical implications.
Conduct disorder in ADHD
Authors: Thapar Anita , van Goozen Stephanie
Published: June 2018

Conduct disorder (CD) is an important marker of ADHD clinical and cognitive impairment and neurodevelopmental multimorbidity. It is also predictive of poor psychiatric and functional outcomes. Although traditionally considered as a consequence of ADHD, association of ADHD and CD can be explained at multiple levels—in terms of enriched familial/genetic risks, higher levels of psychosocial adversity, a likely different pattern of cognitive and neural correlates that involve emotional processes components, earlier temperamental risk characteristics, and additional neurodevelopmental burden such as language impairments and lower cognitive ability. The presence of CD does not alter current ADHD guideline recommendations on treatment but should be taken into account when making decisions upon the intensity and nature of follow-up.
Irritability, disruptive mood, and ADHD
Authors: Mulraney Melissa , Stringaris Argyris , Taylor Eric
Published: June 2018

The chapter ‘Irritability, disruptive mood, and ADHD’ provides an overview of what is known about irritability and disruptive mood dysregulation disorder (DMDD) in children with ADHD. It provides practical guidance for the assessment and management of severe irritability in children with ADHD. The chapter begins by discussing the importance of irritability as a construct, the history of DMDD, and how to measure irritability. It then reviews the literature regarding irritability and mood dysregulation in ADHD and discusses reasons for the overlap between irritability and ADHD. The chapter also reviews what is known about the impact of treatments on irritability in children with ADHD before concluding with suggestions for future research.
Comorbidity
Authors: Oxley Cristal , Stringaris Argyris
Published: June 2018

Anxiety and depression often co-occur in children with ADHD and this comorbidity can also occur across the lifespan. Such comorbidity is associated with adverse outcomes across several domains. The origin of the overlap between these disorders is discussed, including the role of shared risk factors such as common genes, environmental factors, potential association with a third disorder, or as a separate nosological entity. Abnormalities in neurochemistry and findings from imaging studies are discussed. Key components of clinical assessment are discussed together with differential diagnoses, including challenges that clinicians may encounter. Treatment approaches for comorbid ADHD with emotional disorders are outlined.
Autism spectrum disorder
Authors: Bölte Sven , Poustka Luise , Geurts Hilde M.
Published: June 2018

Autism spectrum disorder (ASD) is an early onset and persistent condition defined by alterations in social communication and social interation alongside repetitive, restricted stereotypic behaviours and interests causing disabilities. Until recently, research on the co-occurrence of ADHD with ASD has been limited by DSM-IV criteria, allowing no dual diagnosis of these two neurodevelopmental disorders. Since the DSM-5 permits a double diagnosis of ADHD plus ASD, research on their comorbidity has substantially increased. In addition to shared and distinct aetiological factors, studies have revealed a high clinical impact of the combined symptomatology on individual outcomes. This chapter provides a selective overview of behavioural, cognitive, and biological findings as well as intervention strategies in combined ADHD/ASD phenotypes.
ADHD and sleep
Authors: Mulraney Melissa , Sciberras Emma , Lecendreux Michel
Published: June 2018

The chapter ‘ADHD and sleep’ provides an overview of what is known about sleep in children with ADHD. The chapter begins by discussing normal sleep patterns across the lifespan, how sleep is regulated, and the consequences of insufficient sleep. It then reviews the literature relating to the prevalence and potential causes of sleep problems in children with ADHD. The chapter then provides an overview of both subjective and objective assessment methods of sleep in children with ADHD before reviewing the evidence for and providing recommendations for treatment of sleep problems in children with ADHD. The chapter concludes with suggestions for the future.
The relationship of ADHD to obesity and allergy
Authors: Cortese Samuele , Romanos Marcel
Published: June 2018

Whilst the relationship between ADHD and psychiatric comorbidity is well established, the link between ADHD and somatic conditions has received less attention. However, there is mounting evidence pointing to significant association between ADHD and somatic conditions, including, in particular, obesity and allergic diseases. In this chapter, we review the evidence supporting this link, examine the putative underlying mechanisms, and discuss the possible implications for the management of individuals with both ADHD and obesity or allergic diseases. Overall, whilst the relationship between ADHD and obesity or allergic conditions is currently supported by an increasing body of empirical evidence, the mechanisms underlying the association, as well as the implications of this association on the daily clinical management of patients with ADHD, need further attention.
Cognitive–behavioural treatment in childhood and adolescence
Authors: Döpfner Manfred , Oord Saskia van der
Published: June 2018

Cognitive–behavioural treatment (CBT) in children and adolescents includes: (1) psychoeducation of the patient and their parents/teachers; (2) family-based psychosocial interventions, in particular behavioural parent training; (3) psychosocial interventions in school settings (e.g. classroom interventions and teacher training; academic interventions); (4) cognitive behaviour therapy of the child/adolescent (e.g. social skills training, organizational skills training). A multimodal psychosocial treatment approach, utilizing a combination of several of the CBT interventions, is described. ADHD aims at reducing the ADHD symptoms, psychosocial impairments associated with ADHD, and the related behavioural and emotional problems. Overall, most of these interventions are empirically based interventions that have been shown to be effective in several trials.
Cognitive training approaches for ADHD
Authors: Sonuga-Barke Edmund , Cortese Samuele
Published: June 2018

Computer-based cognitive training, such as working memory training, is increasingly considered a therapeutic option for ADHD. In this chapter we first describe why such an option might be necessary to address limitations in existing treatment approaches and then go on to set out the clinical and scientific rationale for cognitive training for ADHD. We describe the various types of training approaches available and their implementation. This then leads to a review of the evidence from randomized controlled trials for the efficacy of cognitive training as a treatment for ADHD based on recent meta-analyses. We conclude that current evidence, especially considering blinded outcomes, does not support cognitive training as a front-line treatment for ADHD, although it may have beneficial effects by addressing co-occurring working memory deficits. We conclude with a discussion of future directions with an emphasis on the potential value of incorporating cognitive training approaches in early intervention strategies.
Non-stimulants in the treatment of ADHD
Authors: Dittmann Ralf W. , Häge Alexander , Pedraza Juan D. , Newcorn Jeffrey H.
Published: June 2018

The psychostimulants methylphenidate and amphetamine are the most effective and frequently prescribed medications for ADHD. But these agents also have certain limitations; for example, they are controlled substances, and a proportion of patients do not achieve optimal symptom response, or they do not tolerate treatment well. There are two classes of regulatory-approved non-stimulant medications for ADHD, the selective norepinephrine reuptake inhibitors (atomoxetine) and the long-acting alpha-2 adrenergic agonists (guanfacine and clonidine). In addition, several other medication classes have been used off-line with reported efficacy, while others are in clinical development. While the non-stimulant medications are, on average, not as effective as the psychostimulants, they can be very helpful in treating certain patients with ADHD (and respective comorbidities)—either as monotherapy or as adjunctive agents. This chapter reviews a selection of current non-stimulant medications that are clinically used or studied for ADHD.
Death and dying
Authors: Flynn Maria , Mercer Dave
Published: June 2018

An important aspect of nursing practice is caring for people in the last days and hours of their life, whether in a hospice, a clinical environment, or their own homes. Whilst death may be sudden and unexpected, or the anticipated result of an intractable health condition, the effective support of dying people and their families is an important aspect of nursing and care. The UK Leadership Alliance for the Care of Dying People describes key principles to guide nurses who are working with people and families at the end of life. This chapter discusses these principles and considers how they may be translated into general nursing practices. It also discusses the features of loss, grief, and bereavement, and how nurses may continue to support the bereaved after a person has died.
Nursing collectivism
Authors: Flynn Maria , Mercer Dave
Published: June 2018

In ever changing social and political cultures, it is important that nurses are able to work together and support each other in upholding the core values which are important to the profession. Different forms of collective organizations are available for nurses, including professional organizations and trade unions. Despite notional and philosophical differences, workplace practices of the representative organizations tend to be similar, and nurses can accrue particular benefits from membership of a collective. Local organizing strength is often the best predictor of which organization nurses will join, and ultimately collective strength requires mass membership. Professional bodies and trade unions are involved in substantial efforts to maintain strong representation of nurses, and an ultimate goal is the democratization of healthcare workplaces.
Basic knowledge
Authors: Cascarini Luke , Schilling Clare , Gurney Ben , Brennan Peter
Published: June 2018

This chapter discusses basic knowledge in oral and maxillofacial surgery, including Anatomy of the teeth, Dental occlusion, Anatomy of the oral cavity, Anatomy of the facial skeleton, Anatomy of the orofacial muscles, nerves, and glands, Anatomy of the neck, Medical clerking: history and full body examination, Examination of the oral cavity and Examination of the face and neck
Eponyms and maxillofacial syndromes
Authors: Cascarini Luke , Schilling Clare , Gurney Ben , Brennan Peter
Published: June 2018

This chapter provides an Alphabetical list of eponymous maxillofacial syndromes for oral and maxillofacial surgery
Antiepileptic drugs and behaviour: mechanisms of action
Authors: Cavanna Andrea E.
Published: June 2018

Antiepileptic drugs (AEDs) exert their pharmacological properties on both epileptic seizures and behaviour through different mechanisms of action. These include modulation of ion (mainly sodium and calcium) conductance through voltage-gated channels located within the neuronal membrane, as well as facilitation of inhibitory (GABAergic) neurotransmission and inhibition of excitatory (glutamatergic) neurotransmission, resulting in regulation of neuronal excitability.
Levetiracetam, piracetam, and brivaracetam
Authors: Cavanna Andrea E.
Published: June 2018

Levetiracetam is a third-generation antiepileptic drug characterized by a wide range of antiepileptic indications, with a very good interaction profile in polytherapy. Levetiracetam has an acceptable behavioural tolerability profile, but limited potential for psychiatric uses. Behavioural adverse events (irritability and emotional lability) are often reported by patients with epilepsy taking levetiracetam; psychotic symptoms and episodes of severe aggression have occasionally been reported. Initial reports suggesting a possible role for levetiracetam in the treatment of bipolar depression and anxiety disorders have not been confirmed by the findings of controlled trials. Two other pyrrolidone derivatives chemically related to levetiracetam, the nootropic drug piracetam and the third-generation antiepileptic drug brivaracetam, do not have psychiatric uses.
Tiagabine
Authors: Cavanna Andrea E.
Published: June 2018

Tiagabine is a second-generation antiepileptic drug characterized by few antiepileptic indications, with an acceptable interaction profile in polytherapy. Tiagabine has an acceptable behavioural tolerability profile, although its use in the treatment of epileptic seizures has declined. Moreover, treatment with tiagabine has often been associated with depression and irritability (especially in patients with a personal history of affective disorders, or in case of rapid initial titration). Tiagabine has no approved indications or clinical uses in psychiatry. Although tiagabine has been occasionally prescribed off-label as adjunctive treatment for anxiety disorders and neuropathic pain, there is no conclusive evidence for its efficacy in the treatment of any behavioural problems.
Vigabatrin
Authors: Cavanna Andrea E.
Published: June 2018

Vigabatrin is a second-generation antiepileptic drug characterized by a few antiepileptic indications, with a very good interaction profile in polytherapy. Clinically relevant adverse effects (especially visual field defects) have reduced its use as antiepileptic drug in routine clinical practice considerably. Vigabatrin has an acceptable behavioural tolerability profile, although patients with epilepsy treated with this medication can report depression, psychosis, and irritability. Risk factors for developing psychiatric adverse effects include high starting and maintenance doses, past psychiatric history, and epilepsy severity. Vigabatrin has no approved indications or clinical uses in psychiatry, despite weak evidence for its usefulness in the treatment of anxiety disorders and addictions.
Behavioral Assessment of the Spine Patient
Authors: Van Dorsten Brent
Published: June 2018

Behavioral health considerations are key to the evaluation of patients who are suffering from chronic pain or who are under consideration for surgical intervention. Psychosocial factors typically have a tremendous impact on the likelihood of treatment success. Concomitant mood disturbances often exist in the setting of chronic pain and may affect the outcomes of surgical and spinal procedures. Behavioral health assessments may identify factors that should be addressed prior to interventional treatment. Often physicians do not adequately address patients’ expectations. Behavioral health consultations may offer the opportunity to set appropriate patient goals and to assist in the development of coping strategies.
Cervical Disc Disease and Extremity Pain
Authors: Petersohn Jeffrey D.
Published: June 2018

This chapter reviews the anatomic features producing extremity pain, discusses the clinical presentation of cervical disc and spondylotic disease, and explores the differential diagnosis of upper extremity pain. Clinically relevant findings are emphasized in the history and physical examination. Electrodiagnostic and imaging studies necessary to establish a correct diagnosis are highlighted. Common upper extremity nerve entrapment syndromes are discussed. Following a discussion of the anatomic basis for pain, interventional and surgical methods for treatment are briefly compared.
Cervical Spinal Stenosis
Authors: Gutierrez Genaro J. , Chirumamilla Divya
Published: June 2018

Cervical spinal stenosis is the narrowing of the spinal canal. Degenerative cervical spinal stenosis can occur as a result of disc degeneration, osteophyte formation, and hypertrophy of spinal canal ligaments. Diagnosis is primarily made with clinical history and examination in order to assess for classic myelopathic signs (motor weakness, hyperreflexia, and other specific tests). Radiologic imaging is used to validation the diagnosis and to determine the extent of stenosis. Magnetic resonance imaging is the most useful and noninvasive modality. Cervical spinal stenosis without myelopathy can be managed nonsurgically with strengthening, physical therapy, traction, orthosis, and pain management (cervical epidural steroid injections and selective nerve root blocks). Cervical spondylolisthesis has received insufficient attention in comparison to spondylolisthesis of the lumbar spine. It is primarily considered a surgical condition, yet few publications have been dedicated to the topic.
Cervical Spine Trauma
Authors: Reidler Jay S. , Jain Amit , Khanna A. Jay
Published: June 2018

This chapter discusses the diagnosis and treatment of traumatic injuries to the cervical spine. It describes key aspects of the history and physical examination when evaluating patients with suspected cervical spine injuries. Further, it outlines indications for applying cervical collars, steps involved in clearing/removing cervical collars, and recommendations for initial radiographic imaging. Neurologic injuries associated with cervical spine trauma, ranging from “stingers” to complete spinal cord injuries, are described. Common vertebral fracture and dislocation patterns are defined and organized to assist with diagnosis and treatment.
Lumbar Disc Disorders
Authors: Kline Daniel , DePalma Michael
Published: June 2018

This chapter focuses on the diagnosis and treatment of discogenic low back pain. Discogenic low back pain is a prevalent condition that affects a large percentage of the adult population. Diagnosis and treatment of this condition remain challenging despite ongoing advances. Provocation lumbar discography has allowed for more accurate identification of painful discs than conventional imaging techniques. Current research focusing on regenerative treatment options may hold promise for the future.