bluuebunny/crossref_metadata_2025 huggingface dataset:
Pharmacotherapy in patients with cluster a personality disorders
Authors: Völlm B.A. , Farooq S. , Ferriter M. , Jones H. , Smailagic N. , Khalifa N. , Huband N. , Gibbon S. , Stoffers J. , Duggan C. , Lieb K.
Published: May 2011

Background

Among the 10 categories of personality disorders (PDs), interventions for antisocial and borderline personality disorder are best studied. However, the remaining PDs also pose major problems in everyday health care settings. People affected often additionally present with Axis-I disorders such as substance-related, mood or anxiety disorders, and are among those most difficult to treat. Cluster A PDs (paranoid, schizoid, schizotypal) are of particular significance as some authors argue that they may be part of a continuum of mental disorders and be considered as sub-syndrome of schizophrenia

Methods

In the context of Cochrane Collaboration reviews for Cluster A, B and C PDs, exhaustive literature searches were completed to identify the current RCT evidence for PD treatments. Retrievals were assessed and evaluated by two reviewers independently and trials for Cluster A PD were identified.

Results

Only very few (under five) RCTs specifically for Cluster A PDs were identified. Some studies reported on mixed PD samples but it was not always possible to extract data specifically for Cluster A disorders. Participants mostly also suffered from Axis-I disorders. Reported outcomes also focus on Axis-I disorder outcomes or general measures such as overall functioning rather than specific PD symptoms.

Conclusions

The current evidence for psychpathological treatment of Cluster A PD is sparse and does not allow for distinct treatment recommendations. Symptom-driven treatment regimes as suggested by several guidelines are not supported by current evidence.
Diagnosis and differential diagnosis of dementia
Authors: de Mendonça Lima C.A.
Published: May 2011

The European prevalence of dementias will increase of 40% during the next 40 years, with serious effects on families, communities and healthcare systems (1).

A correct diagnosis of dementia is the first step to plan treatment, care and support. There is no single test to identify the cause of dementia. The diagnostic process involves, medical history, mental status exam, physical exam, laboratory tests, psychiatric and (neuro)psychological tests and assessment of individual's functioning. An image of brain is suitable.

There is an idea that this diagnostic process can only be realized by highly specialized staff. WHO has recently published the mhGAP Intervention Guide for use in non-specialized health-care settings by health-care providers working at first- and second-level facilities. It includes guidance on evidence-based interventions to make the diagnosis and manage a number of priority conditions, including dementia (2).

The recent progress in pathological process understanding of Alzheimer's disease (AD), may help to the proposal of new research criteria that reconceptualise the diagnosis around both a specific pattern of cognitive changes and structural/biological evidence of Alzheimer's pathology (3).

These two recent developments are significant contributions to increase the accessibility to a proper diagnosis and care of dementia around the world.
Intentionality of movement: Mirror neuron system and theory of mind
Authors: Borghi A.M. , Binkofski F.
Published: May 2011

The ability to understand intentions of actions performed by others is one of the prerequisites for social interaction. This ability has been attributed to our capacity to mentalize others’ behaviour, by simulating or predicting their mental states that would cause that behaviour and make it comprehensible. Brain imaging studies revealed the so called “mentalizng network” including the pSTS/TPJ, the temporal poles and the medial prefrontal cortex. This network gets constantly activated anytime we try to take the perspective of others or try to simulate their state of mind. On the other hand the discovery of mirror neurons has provided an additional explanation for understanding of the content of actions. The functional properties of these neurons point out that action understanding is primarily based on a mechanism that directly matches the sensory representation of perceived actions with one's own motor representation of the same actions. We provide evidence that both systems interact closely during the processing of intentionality of actions. Thus mentalizing is not the only form of intentional understanding and motor and intentional components of action are closely interwoven. Both systems play an important role in the pathophysiology of schizophrenia.
Posttraumatic disorders in patients with alcohol dependence: Prevalence and integrated treatment
Authors: Schäfer I.
Published: May 2011

Over the past decade, the importance of co-occurring posttraumatic disorders in patients with substance dependence has become increasingly apparent. In clinical populations of addicted patients, about 25 to 50 percent receive a lifetime diagnosis of Posttraumatic Stress Disorder (PTSD). The talk will give an overview of the prevalence of PTSD and other trauma related disorders in European samples of patients with substance dependence. Moreover, data on experiences with the German version of an integrated treatment program for PTSD and substance abuse („Seeking Safety”, Najavits 2002) in N = 38 female outpatients with alcohol dependence will be reported. The results suggest that participants’ satisfaction with the content of the treatment, its structure and the session handouts was high. “Seeking Safety” therefore seems to be a promising treatment also for European patients with the dual diagnosis of PTSD and substance abuse.
Socio-demographic characteristics of the neighborhoods and depression
Authors: Bassi M.
Published: May 2011

Over the 50% of the world's population now is living in the cities and particularly in the large metropolitan areas. Empirical evidence again and again confirms that some features of the context of a large city can influence the mental health of citizens. Faris and Dunham in 1939 were the first to show that the environmental and social disorganization in neighborhoods of Chicago was one of the most important factors to undermine the mental health of residents. This evidence was confirmed by a study carried out in midtown Manhattan, New York City. It suggests that the urban characteristics, such as social and environmental disorganization, could affect the mental health of the residents. Substantial evidence links structural inequalities to health and mental health and the researchers suggest that the disproportionate concentration of recent immigrants in urban neighborhoods contributes to racial and ethnic health disparities. While most part of the studies has examined the relationships between neighbourhood characteristics (e.g. socio-demographic characteristics, stability and mobility of the residents, ethnic composition, public transport, availability of green areas and parks, meeting places for social and cultural events, sport and leisure facilities, shopping centres, health and social services, etc.) and mental health, few studies have examined the factors that contribute to increase the incidence and the prevalence of the depressive disorders. Our research in Milan, Italy, is carrying out at the neighborhoods level, in analysis of intercity comparison, typically focused on the evaluation between environmental characteristics, neighbourhood-specific, and the incidence and prevalence of depression in residents.
Social factors in mental disorders - update on the evidence
Authors: Amering M.
Published: May 2011

Context

Social determinants of mental health and mental illness are classic topics of social psychiatric research and practice.

Objectives

The broad range as well as specific examples of different areas of this field of interest will be presented and discussed with a focus on current research needs.

Key messages

The field of social determinants of mental health and illness ranges from traditional sociological concepts such as social class and gender to recently emerging concepts such as empowerment, social capital and Amartya Sen's capabilities approach.

There is ample evidence that contextual factors on the micro level, such as the role of the family, as well as those on a macro-level such as stigma and dicrimination play a vital role with regard to psychiatric disorders, their treatment and course. Also, internationally emerging policies and research into mental health promotion and prevention clearly show that interventions rely on and vary with social structures and policy strategies in different cultural and economical situations. Current special interest fields in psychiatry such as migration, urbanicity and childhood experiences renew interest into gene x environment interactions as do the dynamic and complex concepts of recovery and resilience.

Conclusions

The large existing evidence base as well as urgent current research efforts such as those into epigenetic mechanisms warrant new vigor in developing and researching variables for further research into the social determinants of mental health and illness.
Values based psychiatry
Authors: Fulford B.K.W.M.
Published: May 2011

Values-based Practice is a new approach to working with complex and conflicting values in medicine. The approach is derived from work in analytic philosophy on the logic of values. As a practical approach, it is based primarily on learnable clinical skills. Values-based Practice has been developed particularly in mental health, through a number of programmes involving both voluntary sector and government organisations in the UK and internationally. Two examples of these programmes will be presented: one related to the use of involuntary treatment in psychiatry; the other arising from a government-sponsored programme on diagnosis and assessment in mental health. Values-based Practice is currently being extended into other areas of medicine as a potential partner to evidence-based practice in clinical decision making
Manifestation and symptomatology of depression in refugees and asylum seekers
Authors: Kastrup M.C.
Published: May 2011

WHO has predicted that in 2020 depression will be the second most important cause of disability.

Studies focusing on cross- cultural aspects of depression have increased during the last decade, and depression has been studied cross-culturally regarding their prevalence and symptomatology.

The WHO study assessing depression across cultures reported a core symptomatology across the participating centres, but with certain differences in the ranking of problems in e.g. patients from non -industrialised nations somatic symptoms often dominate.

Furthermore, there is increasing focus on the impact of migration on depressive illness. Depressive syndromes are clearly very common in migrants, and are probably the most frequent mental disorders in people who move to other countries. Refugees and asylum seekers are subjected to significant social and psychological stress and are more vulnerable. For scientific purposes it is vital though to differentiate between the different aspects of influence, for example the frequency of disorders and problems in treatment. Results of studies on increased psychological morbidity in migrants do not indicate whether increased vulnerability is associated with a migration background, or with acculturation problems in the host country due to cultural differences, or a combination of both factors. Both culture and migration-specific factors, as well as the level of integration into the host country, determine the conflicting arguments.

The presentation will provide an overview of the burden of depression in relation to culture, differences in symptomatology, the role of migration and other circumstantial factors having an impact on the appearance and outcome of the disorder.
Biological rhythms and ADHD
Authors: Kooij J.J.S.
Published: May 2011

The majority of the adults with ADHD have chronic difficulty to go to bed on time. This leads to a shorter sleep duration and daytime sleepiness that may aggravate the inattention problems of ADHD.

This sleep pattern is also known as a delayed sleepphase, and the patients as ‘eveningtypes’. The other way round, eveningtypes have been associated with impulsiveness. The scope of this presentation is to study the impact of this sleep pattern in adults with ADHD on mood (i.e. seasonal affective disorder), eating habits (like timing of meals and binge eating), activity patterns (like nightshift work and light at night) and health in general, i.e. obesity and cancer.
Quality of care and its determinants in rehabilitative mental health care across Europe
Authors: Wright C. ,   Development of a European Measure of Best Practice for People with Long Term Mental Illness in Institutional Care (DEMoBinc) project group
Published: May 2011

The European Commission's Green Paper on Mental Health highlighted the need to improve the social inclusion, human rights and dignity, of mentally ill people. It recognised evidence for improved quality of life and social inclusion provided by deinstitutionalization of services. This study, funded by the EC, explores the relationship between unit characteristics and quality of care, as recorded by the Quality Indicator for Rehabilitative Care (QuIRC).

Method

QuIRC's seven domain scores were analyzed for associations with unit, patient and staff variables, using linear regression.

Results

Unit location affected Living Environment (LE) domain scores. Size of units was associated with all domains apart from Human Rights (HR). Resident characteristics showed single gender, percentage of lower functioning residents, both affected some domains. Staff intensity scores were not associated with any domain of care, but specific disciplines affected particular domain scores Lower quartile results across domains suggest that 25% of European units studied score less than 50% on individual domains’ quality scores.

Discussion

Results suggest the preferability of residential rehabilitation units that are city-based, in the community, smaller in size, and have both men and women residents; where the proportions of detained patients, and patients with a high level of need, are low; and where the staff group includes an employment specialist and a psychologist, but does not include a social worker or a psychiatrist. Average unit performances for different countries in Europe need to be established and considered in developing preliminary quality targets to be reached in particular timescales.
Quality of care in longer term mental health institutions in Portugal
Authors: Cardoso G. , Pacheco C. , Caldas-de-Almeida J.
Published: May 2011

Introduction

Deinstitutionalisation of the mentally ill is an ongoing process in European countries. Quality of care in residential facilities, however, was seldom assessed in part due to the lack of adequate instruments.

Objectives

To assess the quality of care in Portuguese residential facilities for long term mental patients.

Methods

Quality of care in residential facilities was assessed with the toolkit developed by the DEMoBinc study using interviews with the units’ managers, and the users.

Results

The 20 units assessed across Portugal were mainly located in the city; 13 were in a hospital setting and 7 in the community. Most of the units (90%) had no maximum length of stay, and 60% were mixed-gender; 85% of the users were not compulsory. Most of the units (60%) had no one-bedrooms, and their aim was rehabilitative in 40%, and rehabilitative plus providing support in 40%. The rate of patients with a bank account was 49.4%, 32.4% were in charge of their finances, while only 14.1% had voted.

In hospital vs. community units patients were more frequently men (80.5 vs. 53.8%) and older (51.1 ± 13.7 vs. 43.3 ± 9.6, p < .001). In community units the treatment was more frequently explained (50 vs. 26.3%), patients’ involvement was higher (40.4 vs. 19.5%), while mean GAF scores (64.9 vs. 60.2) did not differ.

Conclusions

Portuguese results show that in spite of the effort to create new facilities for the longer term mentally ill, a lot still has to be done to improve the quality of care they provide.
Physical health problems in serious mental illness — Possible solutions
Authors: De Hert M.
Published: May 2011

Metabolic syndrome, obesity, diabetes and other cardiovascular risk factors are highly prevalent in people with SMI. Patients are at risk for premature mortality and the mortality gap with the general population has increased over recent decades. In part these cardio-metabolic risk factors are attributable to unhealthy lifestyle, including poor diet, high rates of smoking, alcohol/substance use/abuse and sedentary behaviour. But over recent years it has become apparent that antipsychotic agents and other psychotropic agents can have a negative impact on some of the modifiable risk factors. Also other somatic co-morbid disorders are also linked to antipsychotic treatment such as the consequences of hyperprolactinaemia, QTc-prolongation and constipation. Other somatic disorders such as poor dental care, HIV and other infectious diseases and some forms of cancer are also more prevalent in patients with schizophrenia. People with SMI also have limited access to effective screening and somatic care. The psychiatrist needs to be aware of the potential somatic side-effects of antipsychotic medication and to include them in the risk/benefit assessment when choosing a specific antipsychotic. He should also be responsible for the implementation of the necessary screening assessments and referral for treatment of any physical illness. Multidisciplinary assessment of psychiatric and medical conditions is needed. The somatic treatments offered to people with severe and enduring mental illness should be at par with general health care in the non-psychiatrically ill population.
Imaging treatment changes in chronic patients and confounding factors
Authors: Martinot J.-L. , Artiges E. , Leroy C. , Paillère Martinot M.-L. , Mana S. , Karila L. , Galinowski A. , De Beaurepaire R. , Trichard C.
Published: May 2011

1/In juvenile patients, a cross-sectional ALE meta-analysis of both brain structure and function regional deviations in 270 articles allowed to cluster the diagnosed disorders into three sets with respectively marked affective, cognitive, and psychomotor phenomenology. The group with affective phenomenology was characterized by abnormalities of the frontal-limbic regions; the group with “cognition deficits” (incl. schizophrenia) mainly related to cortex abnormalities; and the psychomotor condition was associated with abnormalities in the basal ganglia. Therefore, early regional brain abnormalities might interact with the analysis of subsequent treatments effects in MR studies of brain structure and function of chronic mental disorders. 2/In chronic patients, brain imaging studies of antipsychotic drugs using dopamine receptor radioligands &PET scanner have consistently demonstrated the prevalence of their dose-dependent action in basal ganglia. This information has led to theoretical windows for optimal drug dosage. Recent measures of the dopamine transporter in chronic antipsychotic treatment, or in chronic use of drugs of addiction (e.g. tobacco, cannabis) suggest opposite changes of the adioligand uptake in both conditions. Therefore, control for the associated confounding addictions is required for in vivo analysis of antipsychotic action on the dopamine regulation in cortex and subcortical regions. 3/In treatment-resistant patients, MR & PET imaging studies have detected deviations of both brain structure and function, therefore suggesting biomarker of treatment response. 4/Conclusion: stage of illness, addictions, multimodal imaging, should be considered as covariates for brain imaging determinations of treatment effects in patients with chronic mental disorders.
Feasibility and effectiveness of cognitive behavioral analysis system of psychotherapy for chronically depressed inpatients: a pilot study
Authors: Brakemeier E.-L.
Published: May 2011

Background

Cognitive Behavioral Analysis System of Psychotherapy (CBASP) was initially developed and evaluated as an outpatient treatment for chronic depression. Given the high degree of suicidality and comorbidity in chronic depression, however, many of these patients require prolonged inpatient treatment. Here, we report on a first specialized program for chronic depression adapting CBASP to an inpatient setting.

Methods

To evaluate feasibility and effectiveness of this program 30 chronically depressed inpatients were included in an open pilot study. The structured CBASP-based three-month inpatient program combined individual and group therapy sessions.

Results

The majority of the patients suffered from early onset depression, childhood trauma, and a high degree of axis-I and axis-II comorbidity. All patients completed the program perceiving the concept as very helpful. Pre-post comparisons showed significant changes with strong effect sizes. None of the patients deteriorated. In addition, CBASP specific instruments revealed that patients changed their stimulus-character and learned to perform the technique of Situational Analysis. 12 months follow up data show that most patients experienced no relapse.

Conclusion

The findings suggest that a CBASP inpatient program is a feasible and effective short- and longterm treatment for chronically depressed inpatients with high comorbidity rates. A prospective randomized controlled trial will be conducted to validate these promising pilot data.
Cognitive behavioral analysis system of psychotherapy (CBASP) for treatment-resistant depression: Adaptation to a group modality
Authors: Sayegh L.
Published: May 2011

Objective

CBASP has been shown to be an effective treatment for chronic depression using an individual treatment modality but has not yet been tested using a group modality, for treatment-resistant major depression. The primary objective of this study is to evaluate the effectiveness of a CBASP approach adapted to group therapy for treatment-resistant, depressed, psychiatric outpatients. The efficacy of Group-CBASP is examined with regards to various outcomes including depressive symptoms and psychosocial functioning. A secondary objective is to assess whether Group-CBASP improves the psychosocial functioning and decreases the social isolation and avoidance of these patients and helps them develop more adaptive social skills, which becomes a protective factor against relapse into depression.

Results

Group-CBASP is effective in significantly reducing depressive symptomatology. Depression and social adjustment have significantly improved in both overall functioning and in specific role areas. Emotion-oriented coping, which is a maladaptive way of coping using one's emotional reactivity, has significantly decreased. Patients demonstrate more interpersonal confidence and engagement. We can observe a relationship emerging between the use of task-oriented coping strategies and a decrease in interpersonal distress. Finally, interpersonal dominance appears to be associated with improvements in depression and coping skills.

Conclusion

The next step involves the inclusion of a behavioural-activation comparison group to determine if Group-CBASP is contributing uniquely to these changes.
Biochemical and biophysical aspects of the pathophysiology of first episode of schizophrenia
Authors: Uzbekov M. , Smolina N. , Syrejshchikova T. , Misionzhnik E. , Gryzunov Y. , Dobretsov G. , Tokarev V.
Published: May 2011

Introduction

The knowledge of pathophysiology of first psychotic episode is still fragmentary.

Aim

To investigate some biochemical and biophysical parameters in first-episode, drug-naive schizophrenic (FES) patients.

Methods

26 FES patients (ICD-10; F 20.0 and F 20.3) and 15 age-and gender-match volunteers were investigated. Clinical severity of FES patients were assessed by PANSS scale. Platelet monoamine oxidase (MAO) and serum semicarbazide-sensitive amine oxidase (SSAO) activities, middle-mass endotoxic molecules (MMEM) and malondialdehyde (MDA) levels were measured using respective methods. Steady-state and subnanosecond fluorescent spectroscopy were used for the investigation of albumin conformational changes

Results Severity of disorder prior the treatment was 75.5 ± 2.2 (PANSS score). FES patients were characterized by significant increase in MAO activity (99%) and MMEM concentration (124%) and significant decrease in SSAO activity (26%) as compared with controls. Changes of albumin conformational and functional parameters (“effective” albumin concentration and“reserve” of albumin binding) estimated by steady-state fluorescent spectroscopy were insignificant. Factor analysis revealed that MAO and SSAO are more tightly connected with pathogenetic mechanisms of FES then MMEM, MDA and albumin functional parameters. Significant conformational changes of albumin of FES patients were detected using pulse fluorescent spectroscopy with subnanosecond resolution. Results are compared with the data received in chronic schizophrenic patients.

Conclusion

From pathophysiological point of view FES is the initial step in development of pathologically disturbed biochemical status characteristic to chronic schizophrenia.

The study was supported by grant # 3156 from International Science and Technology Center (ISTC).
SOA03-01 - Eating disorders: State of the art
Authors: Treasure J.
Published: May 2011

The DSM V will probably include four categories of eating disorders, anorexia nervosa, bulimia nervosa, binge eating disorder and eating disorder not otherwise specified. The lifetime prevalence is about 5%. Cultural, social and interpersonal elements can trigger the onset and changes in neural networks can sustain the illness. Brain based explanatory models have been developed which include an imbalance between top down control and hedonic and homeostatic elements. The longer the duration of untreated illness the harder it is to reverse the illness as a variety of maintaining factors develop. CBT remains the treatment of choice for bulimia nervosa but there is more uncertainty about treatment for anorexia nervosa although treatment with a focus on the interpersonal elements is of value
SS06-01 - Are we getting the most out of combination therapy in the short-term and long-term treatment of mania?
Authors: Kasper S. , Vieta E. , Bellivier F. , Frye M.
Published: May 2011

The extensive research into the treatment of bipolar disorder over the last 20 years means that we, as clinicians, have never been in a better position to treat patients with bipolar disorder. Yet despite the availability of modern, evidence-based treatment guidelines, bipolar disorder remains an everyday treatment challenge. Newly diagnosed patients requiring treatment for the first time are not always adequately controlled with single-agent therapy and, similarly, combination therapy is also frequently necessary as maintenance treatment. But with this recognition comes the new challenge of identifying when monotherapy is not enough, which agents to combine, when and for how long? How do we know?

Joined by an internationally respected faculty, Professor Siegfried Kasper chairs a discussion to help answer some of the key questions facing clinicians today:

What response can be anticipated from recommended first-line monotherapies for acute mania?

How do we know whether the response we observe when we prescribe a first-line treatment in a manic patient is adequate?

To what extent can a partial non-response to monotherapy be improved by the addition of a second agent?

What's the benefit of maintaining combination treatment once patients are stable and how long should I continue?

Does adding an antipsychotic to a mood stabiliser increase the risk of adverse events, in the short term or in the long term?

Drawing on latest guideline recommendations, recent clinical research, case studies and their extensive clinical experience, the panel will debate these interesting questions and shed light on how we can optimize both acute and maintenance treatment in this patient group.

Although the design of maintenance studies in bipolar disorder has significantly evolved in recent years, individual study designs continue to differ in important ways, with important implications. What may appear to be small differences between study designs, such as the type of most recent episode experienced by the patients or the stabilisation criteria used in the trial, can have big implications for study outcome. It is thus becoming increasingly important to be able to evaluate the results of trials within the context of the design and determine what they mean for treatment practice. Our panel will therefore also discuss the extent to which the design of bipolar maintenance studies can influence the results achieved and share their views on what this means for treatment now, and in the future.

Are we, and more importantly our patients, getting the most out of combination therapy for bipolar mania? Come and debate the issues with the panel, share your views and see what can be achieved.
Schizophrenia: An update
Authors: Fleischhacker W.
Published: May 2011

Schizophrenia is a serious mental disorder which presents with both diagnostic and management challenges. In process of developing DSM5, the inclusion of a Psychosis Risk Syndrome is currently being discussed. This is also the focus of early intervention programs which should facilitate to diagnose the disorder as early as possible and to prevent long durations of untreated psychosis (DUP). As only about 20–40% of young people with At Risk Mental States (ARMS) develop a full blown psychotic disorder, the challenge is to identify people with ARMS who will eventually receive a diagnosis of schizophrenia. Various interventions have been evaluated in ARMS probands, yet it is still too early to make management recommendations.

Once the diagnosis of schizophrenia has been established, treatment must commence as early as possible, in order to prevent long DUP's. First episode patients show a very good chance of remission, 40–60% have been reported.

It is generally recommended to switch patients to clozapine after two or three different antipsychotics have been unsuccessfully tried. In the case of clozapine non-response, the evidence for further interventions becomes extremely weak.

Once improvement and/or remission has been achieved, maintenance treatment is the next big challenge. As most relapses are related to compliance problems, assuring a positive therapeutic relationship with an influence on compliance behavior becomes a key issue.

Managing schizophrenia patients requires expert skills, ideally provided by multiprofessional teams both in inpatient and outpatient settings. Sufficient attention must also be given to the somatic health of schizophrenia patients.
Dementia
Authors: Ihl R.
Published: May 2011

Introduction

In developed nations more than 20% of the population are older than 65 years. Around 8% of this group are estimated to suffer from dementia. For Europe, this means 12–15 million patients and at least the same number of relatives are confronted with dementia. Thus, dementia must be a priority theme in science.

Objectives

Causes, diagnostics, therapy and services in dementia.

Aim

To give an update.

Methods

For new developments in dementia research, guidelines and recent research articles were screened. Resulting facts were grouped in the areas causes, diagnostics, therapy and services.

Results

In research on causes no breaking news could be detected. For diagnostics, new attempts were proposed. Recent treatment guidelines were developed (for example of the WFSBP). In comparison of nations and even within nations service structures are heterogeneous.

Conclusions

In the field of dementia the lack of breaking news demonstrates how necessary research will be. Some nations have developed national dementia action plans. A European dementia action plan might improve our knowledge on dementia and, moreover, improve the actual situation of patients and care givers.
EPA Guidance on Quality of Mental Health Services
Authors: Gaebel W.
Published: May 2011

Introduction

Central to improving quality of mental health services is an optimization of the structures and processes provided to people with mental disorders in Europe.

Objectives

To improve the quality of mental health services in Europe by developing a European guidance focusing on the quality of mental health service structures in Europe.

Aims

The main aim of this guidance is to provide recommendations based on the best available evidence for optimal structures of mental health services by identifying and evaluating the available evidence including a comparison between the efficacy of different service structures wherever possible.

Methods

Systematic literature review and expert consensus survey about questions of the structural and process quality in European mental health services.

Results

Sixteen recommendations were developed for mental health service structures, five for mental health service processes, and four for both mental health services and structures. The recommendations span a large number of mental health services factors including - among others - structural aspects of mental health services, psychiatric workforce numbers, kinds of inpatient and outpatient services and their integration, mental health monitoring and mental health education, admission procedures and safety aspects.

Conclusions

Evidence regarding the quality of mental health services is mainly limited due to the small number of studies and the national or regional peculiarities of mental health service structures which make generalizations difficult. Nevertheless, twenty-five recommendations could be arrived at and future research should aim at investigating whether the implementation of these guidelines is effective in improving European mental health service structures.
The molecular and functional network in SSRI treatment
Authors: Lanzenberger R.
Published: May 2011

Selective serotonin reuptake inhibitors (SSRI) are blocking the serotonin transporter and decreasing the re-uptake of serotonin from extracellular space into the neuron. This mechanism increases time-dependently the serotonin level in the extracellular space, e.g. in the synaptic cleft. However, several adaptive processes including receptor subtypes and transporter down- and up-regulation, desensitization of autoreceptors in the raphe nuclei, increase of neurotrophic factors as the BDNF, etc. have been attributed to the therapeutic response. Increase of serotonin in the extracellular space is an inssuficient explanation of treatment effects according to the latency in the therapeutic response and the in- and decrease in gene expression of several hundreds of genes during SSRI treatment. Network models with the involvement of several core players in this neuroplastic process are necessary. The main focus will be within the serotonergic system using promising neuroimaging methods as molecular neuroimaging with PET and functional magnetic resonance imaging.
Polymorphism of waxy proteins in Spanish hulled wheats
Authors: Guzmán C. , Caballero L. , Gutierrez M. V. , Alvarez J. B.
Published: May 2011

Hulled wheats are neglected crops that have potential in plant breeding programmes of modern durum and common wheat. Among these wheats, three species were widely cultivated in Spain until the mid 20th century:Triticum monococcumssp.monococcum(einkorn),Triticum turgidumssp.dicoccum(emmer) andTriticum aestivumssp.spelta(spelt). One important aspect of wheat grain quality is starch composition, which is related to the action of waxy proteins. A collection of 536 accessions of Spanish hulled wheats was analyzed for waxy protein composition using sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE). Polymorphism was found for the Wx-A1, Wx-B1 and Wx-D1 proteins, including new and null alleles in the three species. An allelic variant with an electrophoretic mobility not previously described was found in einkorn wheat. In emmer and spelt, some alleles with different mobility were also found. AWx-B1null allele was detected in emmer wheat, and null alleles forWx-A1,Wx-B1andWx-D1were found in spelt wheat. The variations found could be used to enlarge the gene pool available to breeders, and to design new cultivars with different levels of amylose content.
Predictive uncertainty analysis of a saltwater intrusion model using null‐space Monte Carlo
Authors: Herckenrath Daan , Langevin Christian D. , Doherty John
Published: May 2011

Because of the extensive computational burden and perhaps a lack of awareness of existing methods, rigorous uncertainty analyses are rarely conducted for variable‐density flow and transport models. For this reason, a recently developed null‐space Monte Carlo (NSMC) method for quantifying prediction uncertainty was tested for a synthetic saltwater intrusion model patterned after the Henry problem. Saltwater intrusion caused by a reduction in fresh groundwater discharge was simulated for 1000 randomly generated hydraulic conductivity distributions, representing a mildly heterogeneous aquifer. From these 1000 simulations, the hydraulic conductivity distribution giving rise to the most extreme case of saltwater intrusion was selected and was assumed to represent the “true” system. Head and salinity values from this true model were then extracted and used as observations for subsequent model calibration. Random noise was added to the observations to approximate realistic field conditions. The NSMC method was used to calculate 1000 calibration‐constrained parameter fields. If the dimensionality of the solution space was set appropriately, the estimated uncertainty range from the NSMC analysis encompassed the truth. Several variants of the method were implemented to investigate their effect on the efficiency of the NSMC method. Reducing the dimensionality of the null‐space for the processing of the random parameter sets did not result in any significant gains in efficiency and compromised the ability of the NSMC method to encompass the true prediction value. The addition of intrapilot point heterogeneity to the NSMC process was also tested. According to a variogram comparison, this provided the same scale of heterogeneity that was used to generate the truth. However, incorporation of intrapilot point variability did not make a noticeable difference to the uncertainty of the prediction. With this higher level of heterogeneity, however, the computational burden of generating calibration‐constrained parameter fields approximately doubled. Predictive uncertainty variance computed through the NSMC method was compared with that computed through linear analysis. The results were in good agreement, with the NSMC method estimate showing a slightly smaller range of prediction uncertainty than was calculated by the linear method.
Structure of turbulent flow at a river confluence with momentum and velocity ratios close to 1: Insight provided by an eddy‐resolving numerical simulation
Authors: Constantinescu George , Miyawaki Shinjiro , Rhoads Bruce , Sukhodolov Alexander , Kirkil Gokhan
Published: May 2011

River confluences are complex hydrodynamic environments where convergence of incoming flows produces complicated patterns of fluid motion, including the development of large‐scale turbulence structures. Accurately simulating confluence hydrodynamics represents a considerable challenge for numerical modeling of river flows. This study uses an eddy‐resolving numerical model to simulate the mean flow and large‐scale turbulence structure at an asymmetrical river confluence with a concordant bed when the momentum ratio between the two incoming streams is close to 1. Results of the simulation are compared with field data on mean flow and turbulence structure. The simulation shows that the mixing interface is populated by quasi‐two‐dimensional eddies. Successive eddies have opposing senses of rotation. The mixing layer structure resembles that of a wake behind a bluff body (wake mode). Strong streamwise‐oriented vortical (SOV) cells form on both sides of the mixing layer, a finding consistent with patterns inferred from the field data. The predicted mean flow fields show that flow curvature has an important influence on streamwise variation of circulation within the cores of the two primary SOV cells. These SOV cells, along with vortices generated by flow over a submerged block of sediment at one of the banks, strongly influence distributions of the streamwise velocity and turbulent kinetic energy downstream of the junction. Comparison of the eddy‐resolving simulation results with predictions from the steady Spalart‐Allmaras RANS model shows that the latter fails to predict important features of the measured distributions of streamwise velocity and turbulent kinetic energy because the RANS model underpredicts the strength of the SOV cells. Analysis of instantaneous and mean bed shear stress distributions indicates that the SOV cells enhance bed shear stresses to a greater degree than the quasi‐two‐dimensional eddies in the mixing interface.
A correction factor to account for mixing in Ghyben‐Herzberg and critical pumping rate approximations of seawater intrusion in coastal aquifers
Authors: Pool María , Carrera Jesús
Published: May 2011

The classic Ghyben‐Herzberg estimate of the depth of the freshwater‐saltwater interface together with the Dupuit approximation is a useful tool for developing analytical solutions to many seawater intrusion problems. On the basis of these assumptions, Strack (1976) developed a single‐potential theory to calculate critical pumping rates in a coastal pumping scenario. The sharp interface assumption and, in particular, this analytical solution are widely used to study seawater intrusion and the sustainable management of groundwater resources in coastal aquifers. The sharp interface assumption neglects mixing and implicitly assumes that salt water remains static. Consequently, this approximation overestimates the penetration of the saltwater front and underestimates the critical pumping rates that ensure a freshwater supply. We investigate the error introduced by adopting the sharp interface approximation, and we include the effects of dispersion on the formulation of Strack (1976). To this end, we perform numerical three‐dimensional variable density flow simulations. We find that Strack's equations can be extended to the case of mixing zone if the density factor is multiplied by an empirically derived dispersion factor [1 − (αT/b′)1/6], where αT is transverse dispersivity and b′ is aquifer thickness. We find that this factor can be used not only to estimate the critical pumping rate but also to correct the Ghyben‐Herzberg estimate of the interface depth. Its simplicity facilitates the generalization of sharp interface analytical solutions and good predictions of seawater penetration for a broad range of conditions.
Does earlier snowmelt lead to greater CO2 sequestration in two low Arctic tundra ecosystems?
Authors: Humphreys Elyn R. , Lafleur Peter M.
Published: May 2011

Some studies have reported that spring warming and earlier snowmelt leads to increased CO2 sequestration in Arctic terrestrial ecosystems. We measured tundra‐atmosphere CO2 exchange via eddy covariance at two low Arctic sites (mixed upland tundra and sedge fen) in central Canada over multiple snow‐free periods to assess this hypothesis. Both sites were net sinks for atmospheric CO2 in all years (2004–2010), but with high interannual variability. Despite a large range in snowmelt date (30 days), we did not find a statistically significant correlation between seasonal accumulated net ecosystem production (NEP) and snowmelt for either site. Although many factors can influence seasonal total NEP, our analysis shows that annual variations in photosynthetic capacity, likely driven by changes in leaf area, is a dominating control at these Arctic sites. At the upland tundra site, protection of overwintering buds by a longer duration of deep snow appears to be linked to greater photosynthetic capacity and NEP. Whereas at the fen site, sedge growth benefits from earlier snowmelt resulting in a strong correlation with early season NEP and an increase in total study period NEP with increasing growing degree days. These results highlight the complexity of interannual variation in ecosystem CO2 exchange in Arctic tundra and suggest that snowmelt date alone cannot predict seasonal, or annual, NEP.
Cease and desist: modulating short‐range Dpp signalling in the stem‐cell niche
Authors: Harris Robin E , Ashe Hilary L
Published: May 2011

Drosophila ovarian germline stem cells (GSCs) are maintained by the extracellular BMP2/4 orthologue Dpp, which is produced from the surrounding somatic niche. The Dpp signal has a short range; it induces a response in GSCs within the niche, but is rapidly extinguished in their progeny only one cell‐diameter away. To ensure the correct balance between stem‐cell maintenance and differentiation, several regulatory mechanisms that modulate the Dpp signal at many stages of the pathway have been described. Here, we discuss the nature of the ovarian Dpp signal and review the catalogue of mechanisms that regulate it, demonstrating how the exquisite modulation of Dpp signalling in this context can result in precise and robust control of stem‐cell fate. This modulation is applicable to other stem‐cell environments that use BMPs as a niche signal, and the regulatory mechanisms are conceptually relevant to several other stem‐cell systems.
Multimodal plasmon coupling in low symmetry gold nanoparticle pairs detected in surface-enhanced Raman scattering
Authors: Dreaden Erik C. , Near Rachel D. , Abdallah Tamer , Talaat M. Hassan , El-Sayed Mostafa A.
Published: May 2011

We report on surface-enhanced Raman scattering of silicon phonon vibrations from arrays of gold nanoprism pairs fabricated by electron beam lithography. We found that resonant excitation of the quadrupolar surface plasmon mode of the nanoprisms increases Raman scattering intensity from the substrate as the distance between the nanoparticle pairs decreases. Finite element modeling and plasmon coupling theory indicate that symmetry is reduced as the nanoparticles approach, resulting in increased dipole-quadrupole coupling. Plasmonic enhancement of the incident and Raman-scattered photons results from the dipolar component of the mixed plasmonic field. This effect is expected to be largest in assemblies/aggregates of nanoparticles.
Vibron frequencies of solid H2 and D2 to 200 GPa and implications for the P–T phase diagram
Authors: Goncharov Alexander F. , Hemley Russell J. , Mao Ho-kwang
Published: May 2011

Vibrational spectroscopy of the intramolecular stretching mode (vibron) of the hydrogen isotopes has been used for the past 20 years in different laboratories using various techniques to probe phase diagrams of this system under extreme conditions. Available vibrational spectroscopy data in hydrogen and deuterium to 200 GPa at 10–300 K are analyzed and reassessed to identify the existence of an additional molecular phase (I′) to phases I, II, and III previously identified at megabar pressures. The results do not support the existence of phase I′ in the pressure–temperature range studied. Previously proposed boundaries between phases I, II, and III are re-examined and updated phase diagrams of hydrogen and deuterium are proposed.