bluuebunny/crossref_metadata_2025 huggingface dataset:
Consultation—Liaison Psychiatry in General Practice
Authors: Carr Vaughan J. , Lewin Terry J. , Walton Jane M. , Faehrmann Catherine , Reid Alexander L. A.
Published: January 2008

Objective:This paper describes the characteristics of 303 consecutive referrals, over a 12-month period, to a consultation—liaison (C—L) psychiatry service provided to eight group general practices in Newcastle, Australia.

Method:A purpose designed service audit form was used throughout the evaluation period to collect information about demographic characteristics, reasons for referral, service contacts, psychiatric diagnoses and clinical management. In addition, patients were invited to participate in a separate, prospective outcome evaluation study, which involved structured interviews and questionnaires.

Results:The most common reasons for referral were: depression (33%); anxiety (12%); diagnostic assessment (9%); and impaired relationships (8%). The most common psychiatric diagnoses were: mood disorders (29%); mild, transient conditions (29%); anxiety (14%); and substance abuse disorders (12%). Following the psychiatric consultation(s), GPs were actively involved in patients’ treatment in 53% of cases. However, there was a higher than expected rate of referral (44%) to another mental health agency. Selected comparisons are also reported between patients referred to the C—L service (n = 303) and a sample of non-referred GP attenders (n = 535).

Conclusions:As expected, the diagnostic profiles of patients attending the C—L service differed in several respects from those using similar services in general hospitals. There were comparatively low rates of organic brain syndromes, suicide risk evaluations, and problems of differential diagnosis of somatic symptoms. Greater emphasis needs to be placed on more formal psychiatric education for GPs, on ways of screening out from the referral process those patients with mild, transient conditions who do not require specialist expertise, and on the development of strategies to help GPs manage such conditions.
Juvenile Obsessive—Compulsive Disorder
Authors: Wever Chris , Rey Joseph M.
Published: January 2008

Objective: To describe the characteristics of a series of children and adolescents with obsessive—compulsive disorder (OCD) and evaluate the outcome of treatment.

Method:Type of symptoms, severity before and after treatment and factors associated with outcome were examined in a large group (n = 82) of consecutive OCD cases referred for treatment.

Results:Most children (95%) had both obsessions and compulsions. Symptoms had been present for 2 years on average. Seventy-one per cent (n = 57) of all eligible patients completed a combined behavioural and pharmacological protocol. Among these, there was a 68% remission rate and a 60% decrease of symptoms at 4 weeks. Comorbidity with oppositional defiant disorder and high aggression scores were associated with poor outcome.

Conclusions:Juvenile OCD can be treated effectively in a standard clinical setting. Treatment programs of the kind described are accepted by young people. It remains to be seen whether in this age group a combined treatment produces better results than medication alone or cognitive—behaviour therapy alone.
Swimming against the Tide? A Review of the Therapeutic Community
Authors: Schimmel Paul
Published: January 2008

Objective:The therapeutic community is an established psychiatric treatment method which may be in decline. This paper reviews the nature of inpatient therapeutic community treatment, and re-evaluates its role.

Method:The principles and practice of such treatment are summarised, with a focus on the functions of staff.

Results:The inpatient therapeutic community is conceptualised as combining socio-therapeutic treatment, psychotherapeutic treatment, and the advantages of the inpatient setting. This unique treatment environment allows for therapeutic regression while mitigating against anti-therapeutic behavioural regression. Research evidence supports the efficacy of therapeutic community treatment for patients with borderline personality disorder.

Conclusion:Further research is needed to assess its efficacy for other diagnostic groups. This intensive treatment approach may be most appropriate for patients who have proved treatment resistant by other means. Possible reasons for the marginal-ization of therapeutic community treatment are considered. Access to quality inpatient therapeutic community treatment is essential in the provision of a comprehensive psychiatric service.
Myeloneuropathy from Whipped Cream Bulbs Presenting as Conversion Disorder
Authors: Brett Adam
Published: January 2008

Objective:To highlight the complications of nitrous oxide abuse.

Clinical picture:A case is presented of a myeloneuropathy in a 21-year-old woman who had been abusing nitrous oxide, obtained from whipped cream bulbs, who was referred to a psychiatric hospital with a diagnosis of conversion disorder. Nitrous oxide toxicity has been reported in medical and dental professions and a few cases of myeloneuropathy due to induced vitamin B12 deficiency have been reported. This would appear to be the first reported case of myeloneuropathy resulting from nitrous oxide abuse from whipped cream propellants as a recreational drug in the community.

Treatment:Three doses of intramuscular hydroxy cobalamin (1000 μg) over the course of 1 week.

Outcome:Her neurological symptoms and anxiety settled.

Conclusions:Nitrous oxide is becoming more popular as a recreational drug; its complications should be noted and a thorough neurological examination performed if abuse is suspected.
A Family with Autosomal Dominant, Non-Alzheimer's Presenile Dementia
Authors: Dark Frances
Published: January 2008

Objective:A rare family pedigree is described with a multigenerational history of an early onset, non-Alzheimer's dementia consistent with autosomal dominant inheritance. Information on five generations, with 26 suspected or proven cases of dementia, are presented.

Method:Previous work on the family was collated and verified. The pedigree was updated. Thirty-three family members agreed to be interviewed for the present study. Standardised clinical information was obtained using the Cambridge Mental Disorders of the Elderly Examination (CAMDEX) National Adult Reading Test (NART), vocabulary and digit substitution subscales of the Wechster adult intelligence scale — revised edition (WARS-R). Abbot samples were taken for biochemical and genetic analysis.

Results:Fifteen males and 11 females have been affected. The age of onset of dementia in those for whom data were available (n = 12) ranged from 39 to 64 years with a mean of 53 years. The duration of illness ranged from 4 to 14 years and the age at death ranged from 49 to 69 years (mean 62 years). Autopsy data exist for nine cases. In one case the neuropathology was consistent with Alzheimer's disease. In two cases the diagnosis of Pick's disease was made on the basis of frontal or frontal/temporal lobe atrophy without Pick bodies or cells. One case diagnosed as Pick's disease had frontal/temporal lobe atrophy with cells resembling Pick's bodies. In the five remaining cases there were no distinctive neuropathological features to differentiate the type of dementia.

Conclusions:The importance of recognising familial dementia, collating information on multiple generations and prospectively collecting standardised data is discussed.
Child Physical and Sexual Abuse and Eating Disorders: A Review of the Links and Personal Comments on the Treatment Process
Authors: Brown Lisa
Published: January 2008

Objective: The aim of the present paper is to review the available literature on abusive experiences and the development of eating disorders, with particular reference to the theoretical basis of the possible links between them.

Method: The review covers the literature of both interpersonal violence and eating disorders, with special reference to that linking the two fields. Brief case reports and clinical experience from a specialised eating disorders unit are also described.

Results: Despite much theoretical speculation of a causal relation between abuse and eating dysfunction there is a lack of empirical research to confirm such theories, and a dearth of treatment suggestions to deal with the comorbid problems of the patient with an eating disorder and a history of abuse.

Conclusions: There is a need for more clinical and experimental focus in this area, particularly in the study of aetiology and the management of dually affected individuals.
Psychiatric Collaboration in a Paediatric Department
Authors: Menahem Samuel , Roth Dina , Haramati Sara
Published: January 2008

Objective: To review the impact of integrating child psychiatry services into a paediatric department.

Method: Following the arrival of a new head of paediatrics, a mandatory multidisciplinary meeting was set up to review, diagnose and manage selected patients under the care of the paediatricians and/or a child psychiatrist. A prospective audit was undertaken of the patients discussed with a brief review of their outcome. The educational value of the meetings and their overall impact on the department was reviewed.

Results: Over an 8-month period 30 patients were discussed in some detail with diagnoses ranging from a psychiatric disorder to a chronic organic illness, each subjected to the deliberations of the multidisciplinary team of the attending paediatrician, resident staff, child psychiatrist/psychologists, nurses, social worker, etc. Recommendations included further assessment by the psychiatric team, or management by the paediatricians with or without guidance of the former, involvement of an outside agency, etc. Such interventions generally had positive outcomes: at times dramatic, although early discharge often resulted in limited goals. There was also an overall increased awareness within the department of the psychological needs of the child and family and the importance of serious physical illness; this awareness is essential in the training of paediatricians and psychiatric staff.

Conclusion: Closer integration of the two disciplines led to benefits both to the patients and staff. The initiation of a mandatory multidisciplinary meeting facilitated the process, overseen by a psychologically-minded new head of paediatrics. His departure led to a loss of some goals achieved, raising the question as to how such collaboration may be self-generating and ongoing. In addition, the issue of how to deal with those patients with ongoing difficulties not addressed during their limited inpatient stay was unresolved.
Referred Adolescents as Young Adults: The Relationship between Psychosocial Functioning and Personality Disorder
Authors: Rey Joseph M. , Singh Michelle , Morris-Yates Allen , Andrews Gavin
Published: January 2008

Objective: To examine the functioning of young adults who had been referred for psychiatric treatment during adolescence.

Method: A group of 145 adolescents referred at a mean age of 14 years were interviewed at a mean age of 20 years to ascertain their functioning and whether they suffered from a personality disorder.

Results: Having a personality disorder was associated with poor functioning at follow-up independently of adolescent diagnosis. Antisocial personalities were typified by problems with the law, a poor work record and early cohabitation, while other personality disorders were characterised by social isolation and problems in interpersonal relationships. Poor quality of the family environment and having received treatment during the follow-up period were the only developmental variables associated with poor functioning.

Conclusions: Developing a personality disorder and having a poor family environment, rather than having an adolescent disorder, appear to be the factors that result in poor functioning in young adults.
Family Dynamics, Hopelessness and Psychiatric Disturbance in Parasuicidal Adolescents
Authors: Pillay Anthony L. , Wassenaar Douglas R.
Published: January 2008

Objective: Adolescent parasuicide has often been associated with family disturbance, hopelessness and psychiatric disturbance, but little empirical work has been done to verify these clinical impressions.

Method: The present study compares matched groups of hospitalised parasuicidal adolescents, non-psychiatric medically hospitalised adolescents and a control group on measures of family disturbance, hopelessness and psychopathology.

Results: The findings reveal significantly higher levels of family disturbance, hopelessness and depressive symptoms in the parasuicidal group.

Conclusions: The results suggest that prevention and treatment of adolescent parasuicide should focus on both individual and family dynamics.
Depression in Adults with Intellectual Disability. Part 2: A Pilot Study
Authors: Davis Julian P. , Judd Fiona K. , Herrman Helen
Published: January 2008

Objectives: To identify adults with intellectual disability (ID) with a depressive disorder referred to a tertiary consultation clinic for psychiatric assessment; to investigate common presenting features of depression in adults with ID; to assess the utility of visual analogue scale (VAS) measures of emotion/behaviour, the CORE measure of psychomotor disturbance, and substitutive diagnostic criteria in the assessment of depressive disorders in this patient group.

Method: Over a 6-month period 47 patients were seen for psychiatric evaluation. Patients in whom a diagnosis of depression was made were further assessed using: VAS measures of depression, irritability, verbal aggression, physical aggression, temper outbursts, regressed behaviour; CORE measure of psychomotor disturbance; and substitutive diagnostic criteria designed by the authors.

Results: Ten patients were found to have a depressive disorder. Substitutive criteria resulted in a greater rate of diagnosis than standard DSM-IV criteria. The VAS measure of irritability was highly scored for all 10 depressed patients. All 10 depressed patients were assigned to the melancholic subgroup according to CORE score.

Conclusions: Standard assessment measures and diagnostic criteria may require modification to enhance their utility in this patient group. Melancholic features require further investigation.
Transcranial Magnetic Stimulation as Therapy for Depression and Other Disorders
Authors: Kirkcaldie Matthew T. K. , Pridmore Saxby A. , Pascual-Leone Alvaro
Published: January 2008

Objective: To provide an overview of the progress and prospects of transcranial magnetic stimulation as a psychiatric therapy for depression.

Method: Published and unpublished studies of the usefulness of transcranial magnetic stimulation as a therapy for depression were assessed, and characterised in terms of a consistent measure of dosage. Additional information was obtained through correspondence, personal meetings and visits to facilities.

Results: Transcranial magnetic stimulation, a means for inducing small regional currents in the brain, has been used in clinical neurology for some time, and can be used on conscious subjects with minimal side-effects. Early researchers noticed transient mood effects on people receiving this treatment, which prompted several inconclusive investigations of its effects on depressed patients. More recently, knowledge of functional abnormalities associated with depression has led to trials using repetitive transcranial magnetic stimulation to stimulate underactive left prefrontal regions, an approach which has produced short-term benefits for some subjects. The higher dosage delivered by high-frequency repetitive transcranial magnetic stimulation appears to produce greater benefits; scope exists for more conclusive studies based on extended treatment periods.

Conclusions: Repetitive transcranial magnetic stimulation is a promising technology. The reviewed evidence indicates that it may be useful in the treatment of depression, and perhaps other disorders which are associated with regional hypometabolism. Should repetitive transcranial magnetic stimulation prove an effective, non-invasive, drug-free treatment for depression, a range of disorders could be similarly treatable.
Recovery from Post-Earthquake Psychological Morbidity: Who Suffers and who Recovers?
Authors: Lewin Terry J. , Carr Vaughan J. , Webster Rosemary A.
Published: January 2008

Objective: We sought to identify the psychosocial characteristics of high earthquake exposure subjects that were associated with the development of post-disaster morbidity and with recovery.

Method: Data reported are from 515 participants in a longitudinal study of the psychosocial effects of the 1989 Newcastle (Australia) earthquake. Subjects were allocated to three subgroups (low morbidity; recovered; and persistent morbidity) on the basis of their Impact of Event Scale scores across the four phases of the study. Differences between these subgroups were examined on a broad range of variables.

Results: Several background, dispositional, coping style and exposure-related factors characterised those who developed psychological morbidity, only a small subset of which differentiated between those who recovered and those with persistent morbidity.

Conclusions: Post-earthquake morbidity persists longer in those who are older, have a history of emotional problems, have higher neuroticism, use more neurotic defenses, and report higher levels of post-disaster life events.
The Prevalence of Comorbid Anxiety in Schizophrenia, Schizoaffective Disorder and Bipolar Disorder
Authors: Cosoff Susan J. , Hafner R. Julian
Published: January 2008

Objective: The aim of this study to determine the prevalence of anxiety disorders in publically treated psychiatric inpatients with a DSM-IV diagnosis of schizophrenia, schizoaffective disorder or bipolar disorder.

Method: Using the Structured Clinical Interview for DSM-III-R (SCID), 100 consecutive inpatients with a psychotic disorder were examined for the presence or absence of an anxiety disorder. Questionnaire measures of phobias, obsessive-compulsive and general anxiety symptoms were also applied.

Results: The prevalences of social phobia (17%), obsessiv-ompulsive disorder (13%) and generalised anxiety disorder in schizophrenia were relatively high, as were prevalences of obsessive-compulsive (30%) and panic disorder (15%) in bipolar disorder. The proportion of subjects with an anxiety disorder (4345%) was almost identical across the three psychoses, with some evidence of gender differences. Although self-ratings of overall psychiatric symptoms were significantly elevated in those with anxiety disorders, hospital admission rates were not.

Conclusions: Almost none of those with anxíeGty disorders were being treated for them, primarily because the severity of the acute psychotic illness required full diagnostic and therapeutic attention. Patients were generally discharged as soon as their psychotic episode was resolved, with little recognition of the presence of an anxiety disorder. Given that anxiety disorders are relatively responsive to treatment, greater awareness of their comorbidity with psychosis should yield worthwhile clinical benefits.
The Effectiveness of Group Psychological Intervention in Enhancing Perceptions of Control following Spinal Cord Injury
Authors: Craig Ashley , Hancock Karen , Chang Esther , Dickson Hugh
Published: January 2008

Objective: This research investigated the effects of a structured psychological intervention, delivered during hospital rehabilitation, on the perceptions of control in people with spinal cord injury (SCI).

Method: A longitudinal study was designed to assess perceptions of control (using an objective measure of locus of control) in SCI persons who participated in specialised group cognitive-behavioural therapy (CBT) during hospital rehabilitation. The treatment SCI group's responses on locus of control were compared with a control group of SCI persons who only received traditional rehabilitation services during their hospitalisation.

Results and Conclusions: Mean locus of control scores were not high (i.e. external) for both groups and there were no overall group differences on locus of control responses across time in comparison to the control group. However, subjects in both groups who initially perceived life as externally controlled were extracted to form subgroups. The members of the subgroup who received CBT were significantly more likely to feel in control of themselves 2 years post injury compared to similar persons in the control group. Furthermore, an external locus of control was significantly but mildly associated with depressive mood 2 years after the injury. This research suggests that the provision of a structured psychological program in the rehabilitation stage will be beneficial for many SCI persons who feel that they have little control over their lives.
Dysmorphic Concern: Prevalence and Associations with Clinical Variables
Authors: Oosthuizen Piet , Lambert Tim , Castle David J.
Published: January 2008

Objective: The aim of this paper is to describe the development of a questionnaire, the Dysmorphic Concern Questionnaire (DCQ), for the assessment of dysmorphic concern, and to establish correlations with clinical variables.

Method: Consecutive admissions to a psychiatric hospital were surveyed.

Results: The DCQ showed good internal consistency, with most of the variance being explained by a single factor. Strong correlations with distress and work and social impairment lend face validity to the questionnaire. Dysmorphic concern was not significantly influenced by the patient's age, sex or diagnosis. In terms of specific psychotic symptoms, there were weak positive correlations with thought interference and persecutory ideation. However, the strongest correlations were with depressed mood, according to the Beck Depression Inventory (BDI) but not the Montgomery Asberg Depression Rating Scale; the discrepancy was largely accounted for by the “cognitive” depressive items on the BDI. In terms of objective assessment of dysmorphic features, ratings on the Waldrop scale for minor physical anomalies showed no correlation with concern expressed by the patient.

Conclusions: The strong correlation with depressive cognitions suggests that dysmorphic concern is often a reflection of a depressive cognitive set rather than being a diagnosis in itself.
Single Dose Pharmacokinetic Study of Lithium in Taiwanese/Chinese Bipolar Patients
Authors: Lee Ching-Fa , Yang Yong-Yi , Hu Oliver Yoa-Pu
Published: January 2008

Objective: The purpose of this study is to investigate the single dose pharmaco-kinetics of lithium in Taiwanese/Chinese bipolar patients for future interracial comparisons.

Method: Eight bipolar patients took 900 mg of lithium carbonate after overnight fasting. Blood samples of 5 mL were taken after 15 min, 30 min, 45 min, 1 h, 2 h, 3 h, 4 h, 7 h, 9 h, 15 h, 25 h and 31 h after dosing. The computer programs CSTRIP and PCNONLIN were used for pharmacokinetic analysis.

Results: The pharmacokinetic parameters obtained were as follows: Cmax, 0.970 ± 0.170 (SD) mmoi/L; Tmax, 1.59 ± 0.78 h; AUC31h = 548.9 ± 135.4 mmol.m/L; AUC = 722.6 ± 262.7 mmol.m/L; β-half-life = 16.3 ± 7.18 h; K-half-life = 0.613 ± 0.442 h; CIoral = 1.13 ± 0.39 mL/min/kg; Vd/F = 1.43 ± 0.387 L/kg. Most of the pharmacokinetic parameters were within the ranges reported in investigations of Caucasian subjects.

Conclusions: This study showed that racial differences in lithium pharmacokinetics might not exist. We suggest that methodological designs, including method of blood sampling, measurement of lithium, and pharmacokinetic and statistical calculations, be standardised if future cross-ethnic comparisons are to be conducted.
Youth Suicide Attempts: A Social and Demographic Profile
Authors: Beautrais Annette L. , Joyce Peter R. , Mulder Roger T.
Published: January 2008

Objective: The social and demographic characteristics of a New Zealand sample of young people making medically serious suicide attempts were examined and compared with those of a control sample of similar age.

Method: Using a case control design, 129 young people making serious suicide attempts were contrasted with 153 randomly selected community controls on a series of social and demographic characteristics including educational achievement, socioeconomic status, income, occupation, religious affiliation and ethnicity. The age and gender distribution of the sample, and the methods of suicide attempt, were examined.

Results: Almost equal numbers of young males (45.7%) and females (54.3%) made medically serious suicide attempts. The clear majority of serious suicide attempts were by overdose or poisoning (78.3%), with tricyclic antidepressants (38.6%) and paracetamol (37.6%) together accounting for three-quarters (76.2%) of all drug overdoses. Young people who were less well educated and who were from lower socio-economic backgrounds had elevated risk of serious suicide attempts. Conclusions: Young people from socially disadvantaged backgrounds have elevated risk of serious suicide attempt.
The Transmission of Trauma across Generations: Identification with Parental Trauma in Children of Holocaust Survivors
Authors: Rowland-Klein Dani , Dunlop Rosemary
Published: January 2008

Objective: This study examines the phenomenology of intergenerational transmission of trauma with the aim of elucidating the interactional process of transmission within an object relations framework.

Method: The method consisted of systematic textual analysis of semi-structured interviews with six Jewish women born after the war who were children of concentration camp interned Holocaust survivors.

Results: Four superordinate themes were identified: heightened awareness of parents' Holocaust survivor status, parenting style, overidentification with parents' experiences and transmission of fear and mistrust. These were found despite the variation in parental communication.

Conclusions: The data suggest that unconscious processes are at least partially involved in the transmission of trauma. A form of projective identification is proposed as an explanatory mechanism which brings together diverse aspects of the observed phenomena: projection by the parent of Holocaust-related feelings and anxieties into the child; introjection by the child as if she herself had experienced the concentration camps; and return of this input by the child in the form of compliant and solicitous behaviour associated with enmeshment and individuation problems. Further research may establish these phenomena as a particular form of Secondary Traumatic Stress Disorder.
Lunar Cycles and Violent Behaviour
Authors: Owen Cathy , Tarantello Concetta , Jones Michael , Tennant Christopher
Published: January 2008

Objective: It is commonly believed that the full moon exerts an influence on violence and aggression in psychiatric settings. The literature to date is contentious. This study used a robust methodology to examine the hypothesis that there was an increased frequency of violent and aggressive behaviour among hospitalised psychiatric clients at the time of the full moon.

Method: Prospective data were collected in five inpatient psychiatric settings across the Northern Sydney Area Health Service. Morrison's hierarchy of violence and aggression was used to rate behaviour. Lunar phases were clearly defined and Poisson regression used to examine relationships between lunar phase and violence. Extraneous temporal variation was considered.

Results: No significant relationship was found between total violence and aggression or level of violence and aggression and any phase of the moon. Conclusion: Future research could profitably examine the implications of a belief in the lunar effect among health workers in the face of evidence that no relationship exists between violence, aggression and the lunar cycle.
The Role of SPECT Scanning in a Neuropsychiatry Unit
Authors: Velakoulis Dennis , Lloyd John H.
Published: January 2008

Objectives: Single photon emission computerised tomography (SPECT) studies allow the assessment of cerebral blood flow and have been increasingly used as a clinical tool in neurology and neuropsychiatry. This paper examines the contribution of SPECT to the clinical management of patients with neuropsychiatric disorders, in particular patients with atypical or early onset dementia.

Method: All patients admitted to an eight-bed neuropsychiatry unit in a general hospital setting who had undergone SPECT scanning over a 15–month period were reviewed. Information was collected on clinical diagnosis, neuropsychological testing, structural neuroimaging and SPECT.

Results: SPECT abnormalities were present in 88% of patients. The pattern of SPECT abnormality was concordant with structural neuroimaging in 65% of patients and concordant with neuropsychological testing in 82% of patients. The sensitivity and specificity of SPECT was 89%/79% for Alzheimer's disease and 56%/79% for frontotemporal dementias.

Conclusions: SPECT results must be interpreted in the context of other clinical and diagnostic assessments. In no single case was the clinical diagnosis made solely on the basis of a SPECT result. SPECT was of maximum clinical use in the diagnosis of frontotemporal dementias and in confirming the diagnosis of Alzheimer's dementia. SPECT was valuable in Lewy body dementia, vascular dementia and head injury. Its clinical utility in other psychiatric disorders remains unclear.
Psychiatry in Transition: Outcomes of Mental Health Policy Shift in Italy
Authors: Barbato Angelo
Published: January 2008

Objective: To assess the outcomes of changes in mental health policy introduced in Italy in 1978.

Methods: Data on psychiatric services, before and after the policy change, are presented. Effects of change are evaluated through indicators related to four issues: transfer of care, criminalisation of the mentally ill, suicides, and homelessness.

Results: Admissions of new patients to mental hospitals have been stopped and the size of the mental hospital population is now very low (26 per 100 000 population). Psychiatric care has been shifted to community services including general hospital psychiatric units. There has been an overall reduction of psychiatric hospitalisation. However, the provision of residential facilities is inadequate and community services are unevenly distributed across the country. Few negative effects of changing patterns of care have been reported, although the low quality of data limits the validity of such a conclusion. Outcome of care in areas where the full range of community services is available has been rated as satisfactory.

Conclusions: Although care of the mentally ill has been shifted to community services, we lack hard data on the social and clinical outcome of communty care at the nation-wide level. Long-term monitoring and evaluation of community services is a high priority in Italy.
From sealing wax to bone wax: predecessors to Horsley's development
Authors: Gupta Gaurav , Prestigiacomo Charles J.
Published: January 2008

Object

Writers of neurosurgical history have traditionally maintained that the initial use of cranial bone wax for hemostasis in humans was developed and promoted by Sir Victor Horsley, the father of British neurosurgery. A thorough literature review, however, suggests that the use of bone wax for cranial bone hemostasis had its roots more than 50 years before Dr. Horsley's description in 1892. In this study the authors review the sources addressing this issue and establish due credit to the surgeons using bone wax for cranial bone hemostasis before Horsley.

Methods

Primary and secondary general surgery and neurosurgery literature from 1850 to the present was comprehensively reviewed. The key words used in the literature searchers were “bone wax,” “sealing wax,” “cranial surgery,” “Victor Horsley,” “hemostasis,” and “bone hemostasis.”

Results

Although Dr. Horsley's description in 1892 clearly delineates the necessary formula for creating a soft, malleable, nonbrittle wax that would easily promote hemostasis, the literature suggests that sealing wax was commonly used as early as 1850 for hemostasis in cranial bones. Even though there is documentation that Magendie (1783–1855) used wax to occlude venous sinuses in animals, detailed documentation of the constituents are not available. Evidence reveals that surgeons like Henri Ferdinand Dolbeau (1840–1877), professor of external pathology and the surgical clinic (1868–1872) at the Paris hospitals, used bone wax in 1864 for the extirpation of a frontal osteoma/exostoses of the frontal sinus.

Conclusions

The use of bone wax in cranial surgery was described by Henri Ferdinand Dolbeau, 50 years prior to Sir Victor Horsley's report in 1892. Nonetheless, it was Horsley who advocated and popularized its use in neurological surgery as an additional tool in the hemostatic and surgical armamentarium.
A historical hypothesis of the first recorded neurosurgical operation: Isis, Osiris, Thoth, and the origin of the djed cross
Authors: Filler Aaron G.
Published: January 2008

✓A new textual analysis of the central religious aspect of the ancient Egyptian creation myth reveals what appears to be a description of the oldest recorded neurosurgical operation, occurring circa 3000 BC. The analysis results in a hypothesis suggesting that traction reduction was used successfully to reverse a paralyzing cervical spine injury of an early Egyptian leader (Osiris), which inspired the story of his resurrection. The Egyptian mother god Isis, working with the god Thoth (the inventor of medicine), resurrects Osiris by treating his damaged cervical spine. Numerous references in the Papyrus of Ani (Book of the Dead) to Osiris regaining the strength and control of his legs are linked textually to the treatment of his spine. The connection between the intact spine and the ability to rise and stand is used as a distinct metaphor for life and death by the spinal representation of the “djed column” painted on the back of the numerous Egyptian sarcophagi for thousands of years. Controversy over the translation of the vertebral references in Egyptian texts is clarified by considering the specific neurosurgical meanings of hieroglyphs appearing in both the Edwin Smith medical papyrus and in the Papyrus of Ani, and in light of recent scholarly reassessments of those hieroglyphs in the Egyptological literature.
Hippocrates' influence on the origins of neurosurgery
Authors: Chang Anna , Lad Eleonora M. , Lad Shivanand P.
Published: January 2008

✓Hippocrates is widely considered the father of medicine. His contributions revolutionized the practice of medicine and laid the foundation for modern-day neurosurgery. He inspired several generations to follow his vision, by pioneering the rigorous clinical evaluation of cranial and spinal disorders and combining this approach with a humanistic and ethical perspective focused on the individuality of the patient. His legacy has forever shaped the field of medicine and his cumulative works on head injuries and spinal deformities led to the basic understanding of many of the fundamental neurosurgical principles in use today.
Tethered cord syndrome in children: a review
Authors: Bui Cuong J. , Tubbs R. Shane , Oakes W. Jerry
Published: January 2008

✓The treatment of a patient with symptoms of a tethered spinal cord and in whom a fatty infiltrated terminal filum is found is controversial. The authors review their experience and the literature regarding this aspect of occult spinal dysraphism. From experience, transection of a fatty terminal filum in patients with symptoms related to excessive caudal cord tension is a minor procedure that generally yields good results. The most problematic issue in the literature is what patients and symptoms are best suited to surgical treatment.
Cord untethering for lipomyelomeningocele: expectation after surgery
Authors: Cochrane D. Douglas
Published: January 2008

✓Tethering of the conus medullaris is assumed to be the primary cause of the deterioration seen in children with transitional lipomyelomeningocele (LMMC). The inevitability of deterioration has led to the use of prophylactic interventions to stabilize or prevent further clinical deterioration. The author reviewed current literature to define the timing and pattern of deterioration prior to and following initial cord untethering in patients with transitional LMMC, as well as the operative burden that these children bear in exchange for optimized function.
Idiopathic granulomatous hypophysitis
Authors: Brisman Michael H. , Morgello Susan , Silvers Adam , Klein Irwin , Post Kalmon D.
Published: January 2008

A case is described of an elderly woman who presented with headaches, hypopituitarism, and visual disturbances and was found to have idiopathic granulomatous hypophysitis, a rare lesion of the pituitary gland. Preoperative magnetic resonance imaging demonstrated a well-circumscribed lesion, which was isointense on both T1- and T2-weighted imaging and enhanced uniformly with administration of gadolinium contrast enhancement, not unlike a macroadenoma. The present case and 12 other cases from the literature are reviewed.
A technique for endoscopic pituitary tumor removal
Authors: Cusimano Michael D. , Fenton Ronald S.
Published: January 2008

A number of milestones have marked the development of transsphenoidal pituitary tumor resection this century. The introduction of headlamp illumination, followed by the use of the operating microscope and fluoroscopy have allowed neurosurgeons to perform this surgery in a safe and highly effective manner.

With the aid of a case report, we describe the incorporation of endoscopic techniques in pituitary tumor resection. The technique described is minimally invasive, avoiding septal dissection and allowing unsurpassed, unobstructed, and panoramic visualization of the region of interest to the surgeon and operative team.
Endoscopic transsphenoidal resection of a large chordoma in the posterior fossa
Authors: Jho Hae-Dong , Carrau Ricardo L. , McLaughlin Mark L. , Somaza Salvador C.
Published: January 2008

The authors report their encouraging experience using an endoscopic technique for transsphenoidal surgery in a patient with a large chordoma in the posterior fossa. The patient was a 40-year-old man with a 2-year history of progressive ataxia, a memory disorder, and emotional instability. A magnetic resonance (MR) image of the brain revealed a midline posterior fossa mass measuring 4 cm in diameter located between the clivus and the brainstem. The basilar artery and its bifurcation were encased by the tumor, which also distorted the brainstem. The patient had been treated at another hospital for obstructive hydrocephalus with a ventriculoperitoneal shunt and he received fractionated external-beam radiation treatment, although no histological diagnosis was ever made. The authors achieved a subtotal resection of the tumor through the patient's nostril using an endoscopic transsphenoidal technique. The portion of the tumor located behind the basilar artery was not resected to protect the brainstem perforating arteries. The patient showed dramatic improvement of his symptoms postoperatively. Residual tumor located behind the basilar artery was treated by stereotactic gamma knife surgery. This is the first reported case of a large posterior fossa chordoma treated by an endoscopic transsphenoidal technique.
Surgical indications in patients with an intracerebral hemorrhage due to a ruptured middle cerebral artery aneurysm
Authors: Shimoda Masami , Oda Shinri , Mamata Yoshiaki , Tsugane Ryuichi , Sato Osamu
Published: January 2008

The authors retrospectively analyzed surgical outcomes in patients with an intracerebral hemorrhage (ICH) due to a ruptured middle cerebral artery aneurysm. A total of 47 patients with ICH who underwent early aneurysm surgery and hematoma evacuation within 24 hours following onset were studied. The types of ICH were classified into three groups by computerized tomography findings: 1) temporal ICH; 2) intrasylvian hematoma; and 3) ICH with diffuse subarachnoid hemorrhage (SAH). Overall, 25 patients (54%) had a favorable outcome and 18 (38%) died. Prognostic factors that predicted a favorable outcome included age less than 60 years, temporal ICH, World Federation of Neurological Surgeons Grade II or III, absence of a surgical complication, and a hematoma volume of less than 25 ml. In the patients with temporal ICH, eight of nine patients had a good recovery, and no patient developed a surgical complication or a delayed ischemic deficit. The most important predictive factor for a favorable outcome in patients with an intrasylvian hematoma was that they underwent early surgery (within 6 hours after symptom onset). In patients with a temporal ICH or intrasylvian hematoma, the initial neurological examination did not accurately predict outcome. By contrast, in the patients with ICH and diffuse SAH, those who developed an ICH with a volume of 25 ml or greater had a poor prognosis. These results suggest that aggressive surgical treatment should be initiated in patients with a temporal ICH or an intrasylvian hematoma, regardless of neurological findings on admission. In patients with an ICH and diffuse SAH, careful review of surgical indications is required.
A burr hole button device to secure the electrode cable in depth electrode placement
Authors: Kamiryo Toshifumi , Laws Edward R.
Published: January 2008

A simple magnetic resonance imaging-compatible buttonlike device was devised to fix a depth electrode cable securely in the burr hole used for its insertion during surgery for depth electrode placement. The button is tightly fixed in the burr hole and it holds the cable without allowing protrusion or tension on the wound.
Diagnostic biopsy of the motor nerve to the gracilis muscle
Authors: Abouzahr M. Kamel , Lange Dale J. , Latov Norman , Olarte Marcelo , Rowland Lewis P. , Hays Arthur P. , Corbo Massimo
Published: January 2008

A biopsy specimen of the motor nerve to the gracilis muscle was obtained in 151 patients to aid in the diagnosis of neuromuscular disorders. The procedure is simple, safe, and has low morbidity and complication rates. The surgical technique is described. Indications for the use of this technique are motor neuropathy, motor neuron disease, Guillain-Barre syndrome, and mixed neuropathy with prominent motor symptoms.
Quantitative, crossover, double-blind trial paradigm for patient screening for chronic intraspinal narcotic administration
Authors: Levy Robert M.
Published: January 2008

Careful preoperative screening of candidates for indwelling drug administration systems for the relief of intractable pain can help to exclude patients who will not benefit from this technology and predict efficacy in others. Unfortunately, bias on the part of both the treating physician and the patient can inappropriately skew the results of subjective or improperly controlled trials and lead to the implantation of drug administration systems in patients who will not benefit from chronic intrathecal narcotic administration.

The author and his coworkers have designed a quantitative, crossover, double-blind paradigm for screening patients who might otherwise be deemed eligible for chronic intraspinal narcotic administration. This paradigm has been used 31 times in 30 patients; based on the outcome of this testing, 22 patients (73%) underwent implantation of chronic infusion systems. Sixteen (80%) of 20 patients with pain related to cancer underwent pump implantation, whereas only six (60%) of the 10 patients with pain of nonmalignant origin were so treated. Sixteen of the patients (72%) have reported good to excellent relief after pump implantation; this includes 12 (75%) of the 16 patients with pain related to cancer and four (66%) of the six patients with pain of nonmalignant origin.

This screening paradigm thus appears to be both reliable and easily applied and promises to be of assistance in the selection of patients appropriate for this mode of therapy.
Mortality rates, hospital length of stay, and the cost of treating subarachnoid hemorrhage in older patients: institutional and geographical differences
Authors: Taylor Christopher L. , Yuan Zhong , Selman Warren R. , Ratcheson Robert A. , Rimm Alfred A.
Published: January 2008

The risk of disability and death and the cost of medical care are particularly high for patients with aneurysmal subarachnoid hemorrhage (SAH) who are 65 years of age or older. A retrospective analysis of 47,408 Medicare patients treated over an 8-year period was performed to determine whether a relationship exists between the mortality rate and surgical volume for older patients with SAH. The mortality rate, length of stay in the hospital, and cost of treatment for patients with SAH in California and New York were also compared. The mortality rate was 14.3% for patients with SAH who were 65 years old or older and who were treated surgically in hospitals in which an average of five or more craniotomies were performed per year; in hospitals averaging between one and five craniotomies annually the mortality rate was 18.4%; and in those averaging less than one such operation per year the rate was 20.5% (trend p = 0.01). There was no difference in the mortality rate for patients in California versus the rate for those in New York. Surgically and medically treated patients, respectively, left the hospital an average of 6.7 and 5.1 days sooner in California than in New York. The unadjusted average reimbursement from Medicare to hospitals for surgically treated patients averaged $1468 more in New York than in California (p < 0.0001), but was equivalent for medically treated patients in the two states. The mortality rate in older patients who are treated surgically for SAH may be inversely correlated with the annual number of craniotomies performed for SAH in patients 65 years of age or older at a given institution. Hospital stays for patients with SAH are significantly shorter in California than in New York.
Prediction of posterior fossa tumor type in children by means of magnetic resonance image properties, spectroscopy, and neural networks
Authors: Arle Jeffrey E. , Morriss Craig , Wang Zhiyue J. , Zimmerman Robert A. , Phillips Peter G. , Sutton Leslie N.
Published: January 2008

Recent studies have explored characteristics of brain tumors by means of magnetic resonance spectroscopy (MRS) to increase diagnostic accuracy and improve understanding of tumor biology. In this study, a computer-based neural network was developed to combine MRS data (ratios of N-acetyl-aspartate, choline, and creatine) with 10 characteristics of tumor tissue obtained from magnetic resonance (MR) studies, as well as tumor size and the patient's age and sex, in hopes of further improving diagnostic accuracy.

Data were obtained in 33 children presenting with posterior fossa tumors. The cases were analyzed by a neuroradiologist, who then predicted the tumor type from among three categories (primitive neuroectodermal tumor, astrocytoma, or ependymoma/other) based only on the data obtained via MR imaging. These predictions were compared with those made by neural networks that had analyzed different combinations of the data. The neuroradiologist correctly predicted the tumor type in 73% of the cases, whereas four neural networks using different datasets as inputs were 58 to 95% correct. The neural network that used only the three spectroscopy ratios had the least predictive ability. With the addition of data including MR imaging characteristics, age, sex, and tumor size, the network's accuracy improved to 72%, consistent with the predictions of the neuroradiologist who was using the same information. Use of only the analog data (leaving out information obtained from MR imaging), resulted in 88% accuracy. A network that used all of the data was able to identify 95% of the tumors correctly. It is concluded that a neural network provided with imaging data, spectroscopic data, and a limited amount of clinical information can predict pediatric posterior fossa tumor type with remarkable accuracy.