bluuebunny/crossref_metadata_2025 huggingface dataset:
Neurologist, 13 years’ experience, Australia
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter discusses the experience of a Neurologist with a patient who presented with a history of three bilateral convulsive seizures over a period of several months. The Neurologist started him on an adjunct antiepileptic therapy and he became seizure free. However, the situation changed dramatically after a stable period of twelve months. He started having seizures again and his mother was able to recognize that these seizures were different from those he had had one year earlier. Prolonged video-EEG monitoring confirmed the diagnosis of Non-Epileptic Seizures (NES). The Neurologist then referred the patient to a Clinical Psychologist, who used Cognitive Behavioral Therapy and taught him some techniques to cope with the condition. Eventually, the patient and his family were able to manage the NES better with the help of the psychologist. The patient reported a significant improvement clinically with less frequent NES and they learned how to manage the situation without visiting the Emergency Department.
Neurologist, 20 years’ experience, India
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter addresses the experience of a Neurologist who works in outreach epilepsy clinics, which cater to underserved rural patients. There was one patient, in particular, who had had epileptic seizures early in life. The description of these seizures, however, was very different from those that had happened during one of the outreach clinics conducted. The entire emphasis in the description of these seizures was on how the boy had a steady stream of spit emerging from the corner of his mouth. The Neurologist then requested to see another seizure right from the beginning. Within twenty minutes, the boy started to have one of his “seizures.” The boy was lying comfortably, hands folded, eyes shut, and there was foaming saliva at the angle of his mouth. After a few minutes, he opened his eyes and stood up and looked expectantly at the Neurologist as if gauging if the Neurologist was satisfied or not. The Neurologist then explained to the father that the current events seemed to be non-epileptic and told the boy that these “seizures” were definitely going to stop now as he had visited the special clinic. Four weeks later, the boy had not had any more “seizures.”
Therapist with PNES, USA
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter examines the personal experience of a Therapist with Psychogenic Non-Epileptic Seizures (PNES). As a Therapist in private practice, the Therapist strongly believed that to end the stigma of mental health conditions, she needed to own her own mental health disorders. The Therapist could not sit across from her clients every day and tell them not to be ashamed of their debilitating Anxiety, Depression, or Post-Traumatic Stress Disorder (PTSD) and yet hide her own mental illness from the world. As such, the therapist spoke openly on social media about mental health and her own journey, and the Therapist shared positive messages about the disorders she treated—that is, until the therapist’s own experience crossed over from the garden variety “Anxiety and Depression” that she saw every day into a much less widely known disorder, PNES. Then, the Therapist became less of a Therapist and more of a patient, trying to maintain some sort of sanity and perspective afforded to her from her years of training as a therapist.
Psychologist, 9 years’ experience, UK
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter focuses on the experience of a Psychologist who has worked with a great number of people with functional difficulties and Psychogenic Non-Epileptic Seizures (PNES). Working with those with PNES is supposed to be “difficult.” It is a difficult condition to diagnose, difficult for medicine and health services to categorize, and difficult in terms of the feelings engendered in both patient and clinician. Importantly, and often forgotten, is that attacks are profoundly difficult for the person experiencing them as well as his or her family. Personally, the Psychologist did not feel much of that difficulty. The Psychologist has some psychoanalytic tendencies, and is therefore not overly committed to the idea that he can actually make people better, nor is the Psychologist overly put off by uncertainty Ultimately, the Psychologist is drawn to working with people whose problems frustrate easy etiology or resist incorporation into the clear pathways of the modern National Health Service.
Neurologist, 7 years’ experience, Kenya
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter looks at the experience of a Neurologist who has had the privilege to be trained by internationally renowned specialists in epilepsy and Psychogenic Non-Epileptic Seizures (PNES). The diagnosis and management of PNES became more challenging, however, when the Neurologist moved countries to practice as a general Neurologist in a resource-limited regional tertiary referral center in Kenya. There, Neurology remains a poorly taught topic and “neurophobia” is strife; healthcare professionals therefore seem to label everything that falls and shakes as an epileptic seizure or, annoyingly, “unexplained seizure disorder.” Indeed, PNES in sub-Saharan Africa is not very well described in the published literature, and therefore the Neurologist’s introduction of terms such as PNES, transient loss of consciousness, and convulsive syncope were initially met with disbelief. The Neurologist realized early on that all staff, including the trainee doctors, had to be retrained and reminded of the importance of the clinical history and the witness account to make the diagnosis.
New ethics for twenty-first-century psychiatry
Authors: Baum Matthew L. , Savulescu Julian , Singh Ilina
Published: March 2020

New ethics are needed for twenty-first-century psychiatry. This chapter considers innovations in psychiatry that either raise new ethical questions for psychiatry or require a revision of prior understanding of what constitutes ethical behaviour in a psychiatric context. The chapter begins by examining two novel neurointerventions at opposite poles: one at the pole of increasingly specific neuroengineering—based on intervention at neural circuit level, deep brain stimulation is highlighted—and at the opposite pole of ‘specificity’, the therapeutic use of placebos is highlighted. The remainder of the chapter discusses ethical and philosophical issues spurred on by endeavours to enable a future in which psychiatry is increasingly preventative. The discussion is intended to be exemplary, rather than comprehensive; and it is hoped to prompt sustained reflection and debate on these topics in the profession and, in particular, as part of psychiatric training.
Application of research evidence in clinical practice
Authors: Cipriani Andrea , Leucht Stefan , Geddes John R.
Published: March 2020

The aim of evidence-based medicine is to integrate current best evidence from research with clinical expertise and patient values. However, it is known that one of the major challenges for clinicians is to move from the theory of evidence-based medicine to the practice of it. Evidence-based practice requires new skills of the clinician, including framing a clear question based on a clinical problem, searching and critically appraising the relevant literature, and applying the findings to routine clinical decision-making, ideally at the individual patient level. Scientific evidence is increasingly accessible through journals and information services that should combine high-quality evidence with information technology. However, the process is not straightforward, as there are several barriers to the successful application of research evidence to health care. This chapter discusses both the prospects for harnessing evidence to improve health care and the problems that clinicians will need to overcome to practise ‘evidence-based-ly’.
A neuroscience-based nomenclature for psychotropic drugs
Authors: Goodwin Guy M. , Zohar Joseph , Kupfer David J.
Published: March 2020

The World Health Organization classification of psychotropic drugs is unsatisfactory. It employs the so-called ATC (Anatomical Therapeutic Chemical) approach. It has allowed a mix of terminology which recognizes treatment indication, drug chemistry, or pharmacology. An international consortium has now developed the neuroscience-based nomenclature (NbN), which is a multi-dimensional system for classifying psychotropic drugs. It emphasizes their pharmacological profile and, as far as possible, mode of action. The NbN provides a contemporary framework for better informed treatment decisions in the form of a downloadable app. The current ideal is for prescribers to match the symptom profile of the patient to a specific and appropriate psychotropic. At present, this is often mediated by a conventional disease-based naming. NbN, as a pharmacologically driven nomenclature, could be adapted to more complicated multi-axial descriptions of symptom dimensions.
Neurodevelopment
Authors: Zilles Karl , Palomero-Gallagher Nicola
Published: March 2020

The pre- and post-natal development of the human nervous system is briefly described, with special emphasis on the brain, particularly the cerebral and cerebellar cortices. The central nervous system originates from a specialized region of the ectoderm—the neural plate—which develops into the neural tube. The rostral part of the neural tube forms the adult brain, whereas the caudal part (behind the fifth somite) differentiates into the spinal cord. The embryonic brain has three vesicular enlargements: the forebrain, the midbrain, and the hindbrain. The histogenesis of the spinal cord, hindbrain, cerebellum, and cerebral cortex, including myelination, is discussed. The chapter closes with a description of the development of the hemispheric shape and the formation of gyri.
Cognitive neuroscience
Authors: Nobre Anna Christina
Published: March 2020

Cognitive neuroscience is the scientific discipline concerned with understanding the neural mechanisms that support human mental function. As such, it provides an essential foundation for experimental medicine approaches to psychiatric disorders. Advances in cognitive neuroscience translate directly into improved evidence-based stratification, diagnosis, treatment development, and prognosis of disorders of mental health. This chapter reviews the historical roots of the field, the emerging theoretical principles, and its major methods of investigation.
Adherence to treatment in psychiatry
Authors: Chan Amy , Horne Rob
Published: March 2020

Adherence to treatment in psychiatry is pivotal for achieving and maintaining good health outcomes. Yet, despite the vast amount of research into adherence, treatment adherence remains suboptimal. There is a need for everyone to take an active role in addressing non-adherence if we are to realize the full benefits of available treatments. This chapter introduces the concept of adherence and discusses the factors influencing adherence in psychiatry. The adherence literature is then reviewed, and results from past adherence interventions summarized to explain why non-adherence occurs from an individual patient perspective. A perceptions and practicalities approach to adherence is then presented to help guide the design and delivery of patient-centred adherence support. This chapter serves as a practical guide to adherence for health care providers and others interested in supporting adherence to treatment in psychiatry.
Management and treatment of attention-deficit/hyperactivity disorder
Authors: Zuddas Alessandro , Carucci Sara
Published: March 2020

Any treatment plan for attention-deficit/hyperactivity disorder (ADHD) must be based on a comprehensive diagnostic evaluation, being aware of possible concomitant medical or psychiatric conditions. Rather than focusing just on the disorder, subjects should be treated as individuals in their social context; baseline symptom severity, impairments, and strengths should be recorded, as well as any environmental risks and/or protective factors. This chapter presents how to develop a treatment plan and offers an extensive update on current available treatments and the safety of ADHD medications, with practical implications for clinicians.
Neurodevelopmental motor disorders
Authors: Martino Davide , Macerollo Antonella
Published: March 2020

Neurodevelopmental motor disorders are a group of conditions characterized by developmental deficits in learning, control, and execution of motor skills. The pathophysiology of these cognitive–motor dysfunctions involves complex neuronal processes of sensorimotor integration (that is, somatosensory, proprioceptive, visual, and vestibular), as well as motor control pathways (that is, cortico-basal ganglia, cerebello-thalamo-cortical, and intracortical networks). The most common neurodevelopmental motor disorders are tic disorders (including Tourette’s syndrome), stereotypic motor disorder, and developmental co-ordination disorder. Here, the chapter provides a useful clinical guide regarding the phenomenology, pathogenesis, and management of these conditions.
Prion disease
Authors: Nihat Akin , Mok TzeHow , Collinge John
Published: March 2020

Prion diseases are fatal neurodegenerative conditions that may arise sporadically or be inherited or acquired by environmental exposure to infectious prions—transmissible agents composed of multimeric assemblies of misfolded protein. The core clinical features are progressive cognitive decline, accompanied with ataxia, myoclonus, and pyramidal or extra-pramidal motor signs. While the most common form—sporadic Creutzfeldt–Jakob disease—is generally rapidly progressive over weeks or months, inherited prion diseases can span many years, with diverse clinical features readily mimicking other neurodegenerative diseases. Psychiatric features, including agitation, anxiety, depression, hallucinations, and behavioural disturbances, are common in the early stages. Diagnosis can usually be made with confidence by the combination of clinical criteria, diffusion-weighted magnetic resonance imaging, electroencephalogram, and specialized cerebrospinal fluid analysis. Inherited prion disease can be confirmed with prion protein gene analysis, which should be considered in all early-onset dementing and ataxic conditions. It is now becoming clear that the fundamental molecular pathogenesis—seeded protein polymerization—is relevant to other neurodegenerative diseases, notably Alzheimer’s disease.
Dementia with Lewy bodies
Authors: Rajkumar Anto P. , Aarsland Dag
Published: March 2020

Lewy bodies are eosinophilic spherical neuronal intracytoplasmic inclusions. Dementia with Lewy bodies (DLB) is the second most common neurodegenerative dementia. Clinical manifestations of DLB include cognitive impairment, extra-pyramidal symptoms, neuropsychiatric symptoms, and autonomic dysfunction. Studies investigating the epidemiology, pathophysiology, clinical diagnosis, and management of DLB have been exponentially increasing over the past two decades. This chapter begins with a brief history of DLB and its epidemiology. It provides an overview of the pathology of DLB, focusing on its neuropathology, neuroimaging, molecular biology, and genetics. The clinical presentation, diagnosis, differential diagnoses, and clinical course of DLB are presented. This chapter summarizes the current evidence for the pharmacological and non-pharmacological interventions of cognitive, neuropsychiatric, and other symptoms of DLB. Future research directives are highlighted at the end of this chapter.
Traumatic brain injury
Authors: Lepage Christian , Koerte Inga K. , Schultz Vivian , Coleman Michael J. , Shenton Martha E.
Published: March 2020

Traumatic brain injury (TBI) results from blunt trauma, acceleration–deceleration forces, rotational forces, or blast exposure to the head. The injury involves a heterogenous pattern of focal and/or diffuse axonal injury, leading to a wide range of symptoms. The severity of the injury covers the spectrum from mild to moderate to severe, with severe injury leading to possible coma and even death. The range of symptoms, the variability in treatment options, and the prognosis of TBI, as well as the psychosocial implications, make it a complex injury that often calls upon the services of neurosurgeons, neurologists, psychiatrists, psychologists, and rehabilitation specialists to help patients achieve the best possible outcome. This chapter aims to provide an overview of TBI that includes the classification, epidemiology, aetiology, pathophysiology, clinical symptoms, long-term outcome, diagnostic implications, and differential diagnosis, as well as possible treatment options and future directions for research.
Tobacco addiction
Authors: Munafo Marcus , Grabski Meryem
Published: March 2020

Tobacco use is a global concern, due to the associated health risks and the impact of the health consequences of tobacco use on the global economy. It is responsible for over 5 million deaths per year, and even though smoking rates have declined in many high-income countries, they are expected to continue to increase in many low- and middle-income countries. The focus of this chapter is on the epidemiology of tobacco addiction and its biological underpinnings, including the role of genetic influences. The importance of non-nicotine factors in tobacco use is discussed, as well as the use of tobacco in people with mental illness. Finally, currently available treatments for smoking cessation, as well as current policy measures to prevent and decrease tobacco use, are also discussed.
The core dimensions of schizophrenia
Authors: Andreasen Nancy C
Published: March 2020

Schizophrenia is a devastating illness that usually affects many aspects of a person’s life. The symptoms may be divided into two groups. ‘Positive’ symptoms include a variety of psychotic symptoms such as delusions and hallucinations. Although severe, they are less handicapping than negative symptoms such as avolition or anhedonia. Positive symptoms involve the presence of things that should be absent, while negative symptoms involve the absence of things that should be present. Dimensional approaches for classifying symptoms have also become popular in current nosology, proposing three dimensions: positive, negative, and disorganized. The course of the illness evolves over time; a prodrome is often present, followed by illness onset and a variable outcome. Good outcome predictors include good premorbid adjustment, high intelligence quotient, and good social relationships. The pathophysiology of the illness includes genetic, neuropathological, and neurodevelopmental components. A possible association with creativity may suggest reasons why the illness has persisted over many centuries.
Epidemiology and course of schizophrenia
Authors: Jablensky Assen
Published: March 2020

Epidemiological research into schizophrenia has a long and productive history over many decades, since the formulation of the disease concept by Emil Kraepelin in 1896. As a critical counterpart to clinical and biological research, its focus is on the population frequency and distribution of incidence, prevalence, course, and outcome, and the associated risk factors. This chapter presents an overview of the historical landmarks of the epidemiology of schizophrenia, its progress over the years, and the state of current knowledge. It highlights the challenges for its future directions of this research, including the question of whether primary or secondary prevention of the disorder will eventually be possible. The unprecedented growth of basic knowledge about the brain and the human genome opens up novel perspectives in the study of complex disorders, such as schizophrenia, which integrate concepts and tools of genetics, neuroscience, and epidemiology.
Delusional disorders
Authors: Marneros Andreas
Published: March 2020

Delusional disorders are psychotic disorders, characterized by well-systematized and long-lasting delusions, whereas other mental and personality domains usually remain intact. Their main characteristics are: (1) chronicity—they may last several months, years, or decades, and in some patients even lifelong; (2) stability—they usually are stable, that is, they only rarely shift into another psychotic disorder; (3) monosymptomatic—delusions are the only symptom; in some rare cases, they could be accompanied by other symptoms, like hallucinations, but if they occur, they are not prominent and usually derivable from the delusions; (4) monothematic—the delusions have a single theme and only rarely a combination; (5) they are difficult to be treated; and (6) they are autochthonous, that is, independent, and autonomous, having their own clinical features and rules. Their main phenomenological types are: erotomanic, jealous, persecutory and related types, somatic, mixed, and unspecified, whereas the existence of an independent grandiose type is uncertain.
Diagnosis, classification, and differential diagnosis of mood disorders
Authors: Ghaemi S. Nassir , Mauer Sivan
Published: March 2020

This chapter discusses DSM and non-DSM definitions and approaches to mood illness. Before 1980, the concept of manic–depressive illness (MDI) meant both bipolar illness and recurrent unipolar depression. Evidence on diagnostic validators since 1980 has not strengthened that claim and may be interpreted to support the original MDI concept, that is, that bipolar illness and unipolar depression are part of the same overall disease (MDI). As a corollary, the concept of major depressive disorder (MDD) may represent a spectrum of different depressive subtypes: mixed (depression with manic symptoms), melancholic, pure, vascular, and neurotic depression. Each subtype differs from the other, based on diagnostic validators of course, genetics, and biological aspects and/or treatment effects. The scientific evidence for this heterogeneity of MDD appears to weaken the claim dating to DSM-III in 1980 that this condition is a different diagnosis/illness from bipolar disorder. The differential diagnosis of mood conditions is described.
Primary prevention and epidemiology of trauma- and stress-related disorders
Authors: Bragesjö Maria , Holmes Emily A. , Arnberg Filip , Andersson Erik M.
Published: March 2020

Post-traumatic stress disorder and acute stress disorder are mental health conditions with a known onset, and prevention strategies can therefore be used to try to prevent the emergence of the full-blown disorder. This chapter provides an overview of the current evidence-based prevention strategies for post-traumatic stress disorder and acute stress disorder. In the first part, diagnostic and epidemiological features of these disorders are considered. The second part of the chapter reviews the evidence base of current preventive psychological and pharmacological interventions. Although some early trials on primary intervention have shown promising effects, it appears too soon to provide any definite recommendation in clinical practice. Importantly, many current widely disseminated treatments lack evidence, and some interventions (for example, debriefing) may, in fact, have a negative impact on the natural recovery after trauma. This chapter highlights the importance of using science-driven interventions to prevent post-traumatic stress disorder and acute stress disorder.
Management and treatment of stress-related disorders
Authors: van den Heuvel Leigh , Seedat Soraya
Published: March 2020

This chapter discusses the management of stress-related disorders, with an emphasis on post-traumatic stress disorder (PTSD). The chapter aims to provide a synthesis reflecting the scope of interventions that have been investigated in the management of stress-related disorders, mainly in adults, including both established and emerging interventions. The evidence provided to support treatment approaches is primarily gleaned from recent meta-analyses and systematic reviews. The chapter first discusses interventions aimed at preventing PTSD, followed by interventions for treatment of the disorder. With regard to the latter, the chapter reviews psychotherapies and pharmacotherapies in adults and then provides an overview of a number of emerging interventions. The chapter concludes with a discussion of the management of adjustment disorders (ADs).
Basic mechanisms, genetics, targets, and animal models for anxiety disorders
Authors: Kas Martien , Olivier Berend
Published: March 2020

Historically, two extensively studied neurotransmitter systems have been studied in anxiety and anxiety disorders, namely the gamma-aminobutyric acid (GABA) and 5-hydroxytryptamine (5-HT, serotonin) systems. Here, the chapter illuminates the various targets within these systems that have led to treatment or are potentially targets for the treatment of anxiety disorders. Human genome-wide association studies have offered potentially novel candidate genes for anxiety disorders, although replication often failed to confirm the original findings. A complicating factor is the heterogenous classification of anxiety disorders in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) and the complex translational operationalization of anxiety—preclinical and clinical studies use diverging definitions and models of anxiety. Stratification of patient populations based on quantitative biological parameters (rather than diagnosis), as well as functional studies in mice mutant for risk genes using homologous endpoints, might optimize our understanding of the relationships between risk genetic variations and core features of anxiety disorders.
Genetics of anxiety disorders
Authors: Gottschalk Michael G. , Domschke Katharina
Published: March 2020

Genetics of anxiety disorders highlights recent developments in the identification of genetic variation associated with specific phobias, social anxiety disorder, agoraphobia, panic disorder, generalized anxiety disorder, and cross-disorder intermediate phenotypes like neuroticism/negative affectivity, introversion, behavioural inhibition, harm avoidance, and anxiety sensitivity. It reviews evidence gathered by family and twin studies, structural and rare variations, genome-wide association studies (GWAS), candidate genes, gene–environment, and epigenetic approaches. Special focus is placed upon functional hypotheses linked to the serotonergic and catecholaminergic, as well as neuropeptide and neurohormonal, signalling systems, followed by multi-level neurophysiological, neuroimaging, and behavioural investigations of anxiety- and fear-related traits. Special emphasis is put on dimensional psychopathology and biomarkers of disease course, susceptibility, and treatment response to cognitive behavioural therapy or psychopharmacological interventions. Moreover, challenges and perspectives are addressed related to drug discovery, personalized medicine, polygenic risk assessment, relevance to nosological domains, and plasticity of the underlying epigenetic architecture.
The primary prevention of anxiety disorders
Authors: Werner-Seidler Aliza , Hudson Jennifer L. , Christensen Helen
Published: March 2020

This chapter describes the nature of primary prevention of anxiety and reports on evidence for its effectiveness. The chapter first defines prevention before reporting results of a systematic review of randomized controlled trials designed to prevent anxiety. A review of existing trials and associated effect sizes suggests that prevention programmes can be effective in preventing anxiety disorder incidence and symptoms in multiple settings (schools, workplaces, community) across the lifespan. The median effect size at post-test across all studies was 0.21, and 0.25 specifically for cognitive behavioural prevention programmes. Key elements common to prevention programmes are then discussed, including a consideration of programme content and personnel delivering the intervention. Key implementation barriers are raised, together with suggestions for how these might be overcome in order to scale up and offer prevention at a population level. The chapter concludes with a consideration of the impact these programmes could have on anxiety disorder incidence.
Core dimensions of obsessive–compulsive disorder
Authors: Schneider Sophie C. , Storch Eric A , Goodman Wayne K
Published: March 2020

Obsessive–compulsive disorder (OCD) is a chronic, and often severe, disorder that is associated with substantial distress and impairment. Sustained research efforts have led to a better understanding of the classification, aetiology, presentation, and treatment of OCD. Further, the clinical heterogeneity of OCD has led to efforts to identify meaningful subtypes of the disorder, based on age of onset, the presence of comorbid tics, or the focus of OCD symptoms. There is substantial support for a multi-dimensional model of OCD where symptoms are conceptualized as multiple overlapping dimensions, consisting of symmetry/ordering, contamination/cleaning, harm/aggression, or sexual/religious symptoms. Evidence suggests that these dimensions may have differential associations with a range of genetic, neural, and clinical factors. The multi-dimensional approach to OCD is thus a promising future direction for OCD research.
Self-harm
Authors: Kapur Nav , Steeg Sarah , Moreton Adam
Published: March 2020

Self-harm—mainly self-poisoning and self-injury—is an important cause of presentation to health services internationally. The annual incidence worldwide is likely to be in the region of 4 per 1000 adults, with a lifetime prevalence of between 3% and 5% in Western countries. Self-harm is more common in young people and more common in girls than boys. Self-harm has a complex aetiology, with sociodemographic, clinical, environmental, and genetic factors all contributing. It is associated with a greatly increased risk of suicide and death by other causes—1 in 50 people die by suicide in the year after hospital presentation for self-harm. Models of suicidal behaviour may help us to understand how different risk factors link together, but risk scales are unlikely to be useful in practice because of their limited predictive value.
Neural mechanisms in chronic pain relevant for psychiatric interventions
Authors: Berna Chantal , Tracey Irene
Published: March 2020

Chronic pain is a medical health problem affecting almost 20% of the population in Europe, with an important impact on patients’ function, quality of life, social interactions, and mental health. This chapter reviews the current understanding of the processes and neural mechanisms involved in nociception and the regulation of pain perception. Factors susceptible to affect the transition from acute to chronic pain are discussed. Neural and psychological factors, which may participate in maintaining chronic pain states and could be targets for psychiatric intervention, are also presented. These different points together clarify why optimal care for chronic pain patients requires a multi-disciplinary team, with an important role for the psychiatrist.
Public policy and service needs in mental health
Authors: Knapp Martin
Published: March 2020

Mental health problems have a number of complex characteristics: incidence often early in life, but symptoms that can last for decades; considerable distress to individuals and also challenges for their families; social and economic exclusion, including discrimination in employment and other areas; premature mortality, particularly through suicide; and elevated risks of violent or acquisitive crimes. Policies must respond to these challenges to protect rights, pursue efficiency in resource use, and aspire to social justice. The chapter looks at the main drivers of mental health problems and their consequences, which often spread widely across many sectors. The main dimensions of a good policy are discussed: a life-course perspective; commitment to primary prevention; promotion of co-ordinated multi-sector efforts; eradication of stigma and discrimination; involvement of families and communities; and, most importantly, giving individuals with lived experience of mental illness as many opportunities, choice, and control as possible, given their circumstances and health.
Planning and providing mental health services for a community
Authors: Burns Tom , Kendrick Tony
Published: March 2020

The fundamental building blocks of modern mental health services (primary care provision, inpatient wards, and some form of multi-disciplinary community team) are broadly established in high-income countries. In low- and middle-income countries, the availability of each of these three components is highly variable and investment often reflects local traditions and practices. Planning rarely begins with a blank sheet, and while it should be informed by local needs assessment and epidemiology, it is likely to be an exercise in the possible. Strengthening primary care provision and establishing multi-disciplinary teams that can provide outreach to the most severely ill are key to success. Organizational simplicity and stability, coupled with effective liaison with social care, mark effective systems.
Other statistical methods
Authors: Peacock Janet L. , Peacock Philip J.
Published: March 2020

This chapter describes several individual statistical methods that do not fit neatly in the other chapters but which are commonly used in medical research. These include methods used to assess agreement in measurement and reliability studies, the number needed to treat as a measure of efficacy in a trial, life tables, missing data, and analysing cost data. All methods are illustrated with examples.
Neonatal Formulary
Authors: Ainsworth Sean
Published: March 2020

Neonatal Formulary bridges a gap between a standard formulary (stating doses, indications, etc.) and a standard neonatal textbook by expanding information about the conditions for which each drug is used. Much of drug use during pregnancy, lactation, and in neonates and young infants is ‘off license’ (i.e. using licensed drugs but for an indication that is outside the licensed use—in many cases simply because the studies and the licensing application did not include data about neonatal use). The book offers information to allow practitioners to make informed choices whether to use such a drug or not by presenting data from published studies to support such a use. Part 1 concentrates on drug prescribing and drug administration, presenting general information on drug storage, drug licensing, and drug prescribing. It also explains to the reader why the metabolism of drugs differs in premature and sick infants and why the practice of extrapolating doses from adult studies is wrong. Patient safety, excipients, and therapies that affect drug metabolism (such as therapeutic hypothermia) are also covered. Part 2 consists of drug monographs for over 250 drugs that may find use in the neonatal population but which nonetheless may also find use outside the neonatal unit. Each monograph is divided into sections covering use, pharmacology, treatment, drug interactions, or other administration information, supply, and administration, and references. The monographs also contain links to Cochrane Database of Systematic Reviews and national guidelines supported by bodies such as the National Institute for Health and Care Excellence or the Royal Colleges. Part 3 contains brief notes on a range of additional drugs and groups of drugs that are often taken by mothers during pregnancy, labour, or during breast feeding where effects on either the fetus or infant can be seen. This information will help to provide safe and effective prescribing of drugs to all mothers and their babies.
B
Authors: Ainsworth Sean
Published: March 2020

This chapter presents information on neonatal drugs that begin with B, including use, pharmacology, adverse effects, fetal and infant implications of maternal treatment, treatment, and supply of BCG (Bacillus Calmette– Guérin) vaccine, Betaine, Betamethasone, Biotin, Blood, Bosentan, Breast milk fortifiers, Budesonide, and Bupivacaine
E
Authors: Ainsworth Sean
Published: March 2020

This chapter presents information on neonatal drugs that begin with E, including use, pharmacology, adverse effects, fetal and infant implications of maternal treatment, treatment, and supply of Enemas, laxatives, and suppositories, Enoxaparin, Enzyme replacement therapy, Epoetin (recombinant human erythropoietin = rEPO), Epoprostenol and other prostanoids (iloprost and teoprostinil), Erythromycin, Esomeprazole, Ethambutol, and Eye drops (and ointments)
M
Authors: Ainsworth Sean
Published: March 2020

This chapter presents information on neonatal drugs that begin with M, including use, pharmacology, adverse effects, fetal and infant implications of maternal treatment, treatment, and supply of Magnesium sulfate (Magnesium sulphate = former BAN), Mebendazole, Mefloquine, Melatonin, Meningococcal vaccines, Mercaptamine (Cysteamine— former BAN), Meropenem, Methadone, Methyldopa, Methylthioninium chloride (Methylene blue = former BAN), Metoclopramide, Metronidazole, Micafungin, Miconazole, Midazolam, Formula milk thickeners and anti-reflux milks, Milrinone, Misoprostol, Mivacurium, Morphine, and Mupirocin
W
Authors: Ainsworth Sean
Published: March 2020

This chapter presents information on neonatal drugs that begin with W, including use, pharmacology, adverse effects, fetal and infant implications of maternal treatment, treatment, and supply of Warfarin, and Whooping cough vaccine (including tetanus and diphtheria)
Suppressing cosmic variance with paired-and-fixed cosmological simulations: average properties and covariances of dark matter clustering statistics
Authors: Klypin Anatoly , Prada Francisco , Byun Joyce
Published: March 2020

Making cosmological inferences from the observed galaxy clustering requires accurate predictions for the mean clustering statistics and their covariances. Those are affected by cosmic variance – the statistical noise due to the finite number of harmonics. The cosmic variance can be suppressed by fixing the amplitudes of the harmonics instead of drawing them from a Gaussian distribution predicted by the inflation models. Initial realizations also can be generated in pairs with 180○ flipped phases to further reduce the variance. Here, we compare the consequences of using paired-and-fixed versus Gaussian initial conditions on the average dark matter clustering and covariance matrices predicted from N-body simulations. As in previous studies, we find no measurable differences between paired-and-fixed and Gaussian simulations for the average density distribution function, power spectrum, and bispectrum. Yet, the covariances from paired-and-fixed simulations are suppressed in a complicated scale- and redshift-dependent way. The situation is particularly problematic on the scales of Baryon acoustic oscillations where the covariance matrix of the power spectrum is lower by only $\sim 20{{\ \rm per\ cent}}$ compared to the Gaussian realizations, implying that there is not much of a reduction of the cosmic variance. The non-trivial suppression, combined with the fact that paired-and-fixed covariances are noisier than from Gaussian simulations, suggests that there is no path towards obtaining accurate covariance matrices from paired-and-fixed simulations – result, that is theoretically expected and accepted in the field. Because the covariances are crucial for the observational estimates of galaxy clustering statistics and cosmological parameters, paired-and-fixed simulations, though useful for some applications, cannot be used for the production of mock galaxy catalogues.
A bound on the 12C/13C ratio in near-pristine gas with ESPRESSO
Authors: Welsh Louise , Cooke Ryan , Fumagalli Michele , Pettini Max
Published: March 2020

Using science verification observations obtained with ESPRESSO at the Very Large Telescope (VLT) in 4UT mode, we report the first bound on the carbon isotope ratio $\rm ^{12}C/^{13}C$ of a quiescent, near-pristine damped Ly α (DLA) system at z = 2.34. We infer a limit $\rm log_{10}\, ^{12}C/^{13}C \gt +0.37\, (2\sigma)$. We use the abundance pattern of this DLA, combined with a stochastic chemical enrichment model, to infer the properties of the enriching stars, finding the total gas mass of this system to be $\log _{10}(M_{\rm gas}/{\rm M_{\odot }})=6.3^{+1.4}_{-0.9}$ and the total stellar mass to be log10(M⋆/M⊙) = 4.8 ± 1.3. The current observations disfavour enrichment by metal-poor asymptotic giant branch (AGB) stars with masses $\rm \lt 2.4\, M_{\odot }$, limiting the epoch at which this DLA formed most of its enriching stars. Our modelling suggests that this DLA formed very few stars until $\gtrsim 1$ Gyr after the cosmic reionization of hydrogen and, despite its very low metallicity ($\sim 1/1000$ of solar), this DLA appears to have formed most of its stars in the past few hundred Myr. Combining the inferred star formation history with evidence that some of the most metal-poor DLAs display an elevated [C/O] ratio at redshift z ≲ 3, we suggest that very metal-poor DLAs may have been affected by reionization quenching. Finally, given the simplicity and quiescence of the absorption features associated with the DLA studied here, we use these ESPRESSO data to place a bound on the possible variability of the fine-structure constant, Δα/α = (−1.2 ± 1.1) × 10−5.
Detection of the phase curve and occultation of WASP-100b with TESS
Authors: Jansen Tiffany , Kipping David
Published: March 2020

We report the detection of the full orbital phase curve and occultation of the hot-Jupiter WASP-100b using TESS photometry. The phase curve is isolated by suppressing low-frequency stellar and instrumental modes using both a non-parametric harmonic notch filter (phasma) and semi-sector long polynomials. This yields a phase-curve signal of (73 ± 9) ppm amplitude, preferred over a null-model by ΔBIC = 25, indicating very strong evidence for an observed effect. We recover the occultation event with a suite of five temporally localized tools, including Gaussian processes and cosine filtering. This allows us to infer an occultation depth of (100 ± 14) ppm, with an additional ±16 ppm systematic error from the differences between methods. We regress a model including atmospheric reflection, emission, ellipsoidal variations, and Doppler beaming to the combined phase-curve and occultation data. This allows us to infer that WASP-100b has a geometric albedo of $A_g = 0.16^{+0.04}_{-0.03}$ in the TESS bandpass, with a maximum dayside brightness temperature of (2710 ± 100) K and a warm nightside temperature of $(2380^{+170}_{-200})$ K. Additionally, we find evidence that WASP-100b has a high thermal redistribution efficiency, manifesting as a substantial eastward hotspot offset of $(71^{+2}_{-4})^{\circ }$. These results present the first measurement of a thermal phase shift among the phase curves observed by TESS so far, and challenge the predicted efficiency of heat transport in the atmospheres of ultra-hot-Jupiters.
Fundamental differences in the radio properties of red and blue quasars: insight from the LOFAR Two-metre Sky Survey (LoTSS)
Authors: Rosario D J , Fawcett V A , Klindt L , Alexander D M , Morabito L K , Fotopoulou S , Lusso E , Calistro Rivera G
Published: March 2020

Red quasi-stellar objects (QSOs) are a subset of the luminous end of the cosmic population of active galactic nuclei (AGNs), most of which are reddened by intervening dust along the line of sight towards their central engines. In recent work from our team, we developed a systematic technique to select red QSOs from the Sloan Digital Sky Survey, and demonstrated that they have distinctive radio properties using the Faint Images of the Radio Sky at Twenty centimetres radio survey. Here we expand our study using low-frequency radio data from the LOFAR Two-metre Sky Survey (LoTSS). With the improvement in depth that LoTSS offers, we confirm key results: Compared to a control sample of normal ‘blue’ QSOs matched in redshift and accretion power, red QSOs have a higher radio detection rate and a higher incidence of compact radio morphologies. For the first time, we also demonstrate that these differences arise primarily in sources of intermediate radio loudness: Radio-intermediate red QSOs are × 3 more common than typical QSOs, but the excess diminishes among the most radio-loud systems and the most radio-quiet systems in our study. We develop Monte Carlo simulations to explore whether differences in star formation could explain these results, and conclude that, while star formation is an important source of low-frequency emission among radio-quiet QSOs, a population of AGN-driven compact radio sources is the most likely cause for the distinct low-frequency radio properties of red QSOs. Our study substantiates the conclusion that fundamental differences must exist between the red and normal blue QSO populations.
High-redshift cosmography: auxiliary variables versus Padé polynomials
Authors: Capozziello S , D’Agostino R , Luongo O
Published: March 2020

Cosmography becomes non-predictive when cosmic data span beyond the redshift limit z ≃ 1. This leads to a strong convergence issue that jeopardizes its viability. In this work, we critically compare the two main solutions of the convergence problem, i.e. the y-parametrizations of the redshift and the alternatives to Taylor expansions based on Padé series. In particular, among several possibilities, we consider two widely adopted parametrizations, namely y1 = 1−a and $y_2=\arctan (a^{-1}-1)$, being a the scale factor of the Universe. We find that the y2-parametrization performs relatively better than the y1-parametrization over the whole redshift domain. Even though y2 overcomes the issues of y1, we get that the most viable approximations of the luminosity distance dL(z) are given in terms of Padé approximations. In order to check this result by means of cosmic data, we analyse the Padé approximations up to the fifth order, and compare these series with the corresponding y-variables of the same orders. We investigate two distinct domains involving Monte Carlo analysis on the Pantheon Superovae Ia data, H(z) and shift parameter measurements. We conclude that the (2,1) Padé approximation is statistically the optimal approach to explain low- and high-redshift data, together with the fifth-order y2-parametrization. At high redshifts, the (3,2) Padé approximation cannot be fully excluded, while the (2,2) Padé one is essentially ruled out.
A parsec-scale radio jet launched by the central intermediate-mass black hole in the dwarf galaxy SDSS J090613.77+561015.2
Authors: Yang Jun , Gurvits Leonid I , Paragi Zsolt , Frey Sándor , Conway John E , Liu Xiang , Cui Lang
Published: March 2020

The population of intermediate-mass black holes (IMBHs) in nearby dwarf galaxies plays an important ‘ground truth’ role in exploring black hole formation and growth in the early Universe. In the dwarf elliptical galaxy SDSS J090613.77+561015.2 (z = 0.0465), an accreting IMBH has been revealed by optical and X-ray observations. Aiming to search for possible radio core and jet associated with the IMBH, we carried out very long baseline interferometry (VLBI) observations with the European VLBI Network at 1.66 GHz. Our imaging results show that there are two 1-mJy components with a separation of about 52 mas (projected distance 47 pc) and the more compact component is located within the 1σ error circle of the optical centroid from available Gaia astrometry. Based on their positions, elongated structures and relatively high brightness temperatures, as well as the absence of star-forming activity in the host galaxy, we argue that the radio morphology originates from the jet activity powered by the central IMBH. The existence of the large-scale jet implies that violent jet activity might occur in the early epochs of black hole growth and thus help to regulate the co-evolution of black holes and galaxies.