bluuebunny/crossref_metadata_2025 huggingface dataset:
Communication
Authors: Barr Owen , Gates Bob
Published: October 2018

This chapter is underpinned by the assertion that all people with intellectual disabilities can communicate and may use a wide range of means to do so, including verbal, non-verbal, vocal, and gestural approaches. The behaviour of people with intellectual disabilities is also an important factor in understanding their communication, including behaviours that may be viewed as being a challenge or being of concern. A major problem for many people with intellectual disabilities is having the meaning of their communication understood by other people. This chapter explores the key factors that nurses working with people with intellectual disabilities need to know in relation to effective communication and providing accessible information to people with intellectual disabilities. It provides practical information in the use of augmentative and alternative communication systems, as well as information on communication passports, objects of reference, and compiling life stories.
Physical health and well-being
Authors: Barr Owen , Gates Bob
Published: October 2018

This chapter explores in detail aspects of health in children, adults, and older people with severe intellectual disabilities. It reviews why they have higher health needs when compared with the general population. It also identifies the different pattern of physical health needs and the high comorbidity in this group of people, as well as explores how many health needs can remain untreated. It demonstrates that the health profile of people with mild intellectual disabilities is similar to the wider population, once socio-economic factors are taken into account, although importantly they may experience more difficulty in accessing health promotion and primary and secondary care services. As a result of these factors, which include unmet health needs, many people die unnecessarily and at a premature age. This chapter uniquely provides comprehensive coverage of the very many factors compromising health and well-being, along with providing a range of strategies that registered nurses for people with intellectual disabilities can adopt in order to support health and well-being.
Independent regulators of care quality
Authors: Barr Owen , Gates Bob
Published: October 2018

This chapter provides an overview of the role of the independent care regulators across the UK and the Republic of Ireland. It provides information on arrangements for care regulators within the specific jurisdictions of Scotland, England, Wales, Northern Ireland, and the Republic of Ireland. This chapter outlines the role of the independent care regulators in both inspecting and supporting the development of quality in services. Nurses for people with intellectual disabilities need to have a rounded and balanced understanding of the role of these care regulators, as well as the standards and resources they provide, in order to maximize the quality of care provided to people with intellectual disabilities.
Staff selection and training
Authors: Scaillet Chantal , Taylor Celia
Published: October 2018

This chapter on staff selection and training reviews the literature on the qualities and competencies required for working with personality disordered offenders. It also discusses the complexity of working with personality disordered offenders who may have challenging behaviours. It then considers various staffing models and outlines why the direction of multi-agency, partnership working was chosen. It explores the needs of staff at all levels for clinical supervision and reflective practice, and the kinds of dilemmas they are likely to bring for discussion. Finally, the chapter examines the results of various evaluation studies of staff recruitment and training, and suggests possible future developments.
Case identification and formulation
Authors: Minoudis Phil , Shaw Jake
Published: October 2018

The aims of this chapter are twofold. First, it outlines methods by which high-risk offenders with personality disorder can be identified in large samples of offenders. It presents a summary of the available evidence that relates to this task, while also drawing on the authors’ experience of implementing systems of case identification while working in the probation service in the UK. It is argued that adopting proactive systems of case identification not only is achievable but also holds a number of potential benefits. Second, the chapter considers approaches to formulation in the Offender Personality Disorder (OPD) community pathways services. Following a review of the literature and available models, the authors discuss how the London Pathways Partnership selected its current approach and provide a description of its practical application and the lessons learned from our experiences. The chapter ends with a discussion of future directions for both case identification and formulation.
Intervening in the community
Authors: Craissati Jackie , Halsey Rob
Published: October 2018

The Offender Personality Disorder (OPD) pathway strategy explicitly begins and ends with the community, and this ethos lies at the heart of the pathway approach to management. This chapter therefore focuses on the question of how best to deploy limited resources to greatest effect when facing the challenge of high levels of morbidity and offending, a large geographical area, and a changing staff group. Having reviewed the rather sparse literature on relevant and effective community treatment interventions, the authors consider the relative benefits of stand-alone treatment approaches, partnership working, and indirect support, before describing the mixed model chosen by the London Pathways Partnership. The chapter concludes with a reflection on progress and challenges four years on; unbalanced by politically driven changes midway, the service nevertheless has flourished, although partnership working requires constant attention if staff are to be supported to make a real difference.
Meaningful service user participation in the pathway
Authors: Jeffcote Nikki , Van Gerko Karen , Nicklin Emma
Published: October 2018

This chapter describes the context, aims, challenges, and growth of a user involvement programme spanning both prison and community services in the Offender Personality Disorder (OPD) pathway. Involving and empowering high-risk individuals to enhance pathway service provision has the potential to bring significant benefits in terms of social integration, well-being, and desistance from offending, while also requiring careful management of internal and external safety. The chapter describes the particular challenges involved and the support and governance framework that has enabled the user involvement programme to flourish within the London Community Pathway. Successful initiatives are described and service users’ own narrative accounts of their experience of involvement are included throughout. The chapter concludes with a review of the challenges that have emerged as the programme has grown, the learning they have afforded, and ideas for future continuing developments.
Making an impact: Have we got it right yet?
Authors: Craissati Jackie , Campbell Colin
Published: October 2018

This concluding chapter adopts a formulation-based approach to reflect on the tough question of whether the Offender Personality Disorder (OPD) pathway has achieved a real impact in terms of the national strategy’s high-level outcomes. First, the explicit and implicit premises of the former Dangerous and Severe Personality Disorder (DSPD) developments are considered, contrasting them with those underpinning the OPD pathway strategy. It is suggested that while DSPD was predicated on an illness model, the OPD strategy more accurately reflects a public health model, with the associated benefits and disadvantages. Second, the evidence for impact to date is summarized. Third, the high-level strategy outcomes are reworked in line with our theoretical model to achieve a more coherent articulation of the hypothesized mechanism of change within the pathway.
What is addiction?
Authors: Nutt David J. , Nestor Liam J.
Published: October 2018

Substance addiction is defined as a chronic relapsing disorder characterized by (1) compulsion to seek and take a substance, (2) loss of control in limiting substance intake, and (3) the emergence of a negative emotional state (e.g. dysphoria, anxiety, irritability) reflecting a motivational withdrawal syndrome when access to the substance is prevented. Importantly, the occasional but limited use of addictive substances is clinically distinct from escalated substance use, loss of control over substance intake, and the emergence of chronic compulsive substance-seeking that characterizes addiction. Importantly, substance addiction (including alcohol) is a manifestation of the long-term pharmacological actions substances have on receptor mechanisms in brain networks that govern cognitive and psychological processes that have evolved for human survival.
Burden of addiction
Authors: Nutt David J. , Nestor Liam J.
Published: October 2018

The scale and cost of substance abuse to society are enormous. Tobacco addiction, for example, is the leading cause of preventable death in the world, and the cessation of smoking is a critical prerequisite to improving health. Alcohol use disorders have also been found to be among the most disabling single conditions, and drug use disorders are also amongst the most frequent. Significantly, substance addiction is also one of the main causes of global disability in young people. Substances of abuse (e.g. alcohol, tobacco) and addiction, therefore, are major causes of harm to individuals and society, and these costs occur at a number of different levels.
Key elements of addiction
Authors: Nutt David J. , Nestor Liam J.
Published: October 2018

Addiction is characterized by the compulsion to seek and take a substance, the loss of control in limiting substance intake, and the emergence of a negative emotional state (e.g. dysphoria, anxiety) when substance intake is prevented. Importantly, there are elements of addiction that emerge during the addiction trajectory (e.g. liking, wanting, habit, craving) that are a reflection of key changes in the homeostasis of brain networks that control different behaviours. These homeostatic changes ultimately lead to 1) a decreased sensitivity for natural rewards, 2) an enhanced sensitivity for conditioned substance cues and the expectation of substance use rewards, 3) a weakened control over substance use urges and substance-taking behaviour, and 4) substance tolerance and withdrawal. Significantly, these changes are targets for pharmacological and psychological treatment interventions in addiction.
Drug pharmacokinetics and abuse liability
Authors: Nutt David J. , Nestor Liam J.
Published: October 2018

Pharmacokinetics refers to the effect of the body on drugs. Pharmacokinetics is divided into several areas including the extent and rate of absorption, distribution, metabolism, and excretion of substances. The rapid delivery of drugs like cocaine and nicotine, for example, enhances their effects in reward brain circuitry, and the rate at which the body can metabolize a substance may also make it more reinforcing. Pharmacokinetics, therefore, plays an important role in substance abuse and addiction and its treatment.
Pharmacodynamics of addictive substances
Authors: Nutt David J. , Nestor Liam J.
Published: October 2018

Pharmacodynamics refers to the effects addictive substances have on the body. Acutely, substances of addiction target various neurotransmitter systems in the brain. The pharmacological actions of these substances at receptors results in their physiological and psychological effects. The chronic abuse of these substances, however, leads to pharmacodynamic tolerance at receptors within neurotransmitter systems and leads to addiction. This tolerance means that a greater amount of the substance is required to achieve the desired effect and it has significant implications for relapse during early abstinence in addiction. Treatments target these neurotransmitter disturbances in addiction to prevent relapse.
The GABA system and addiction
Authors: Nutt David J. , Nestor Liam J.
Published: October 2018

Research points to the potential role of gamma-aminobutyric acid (GABA) in substance addiction. GABA is the major inhibitory neurotransmitter in the brain. Disturbances in the GABA system may predate substance abuse and addiction, whereby its efficacy to modulate other neurotransmitter systems (e.g. dopamine) strongly implicated in substance addiction behaviours is impaired. There are a number of addictive substances that boost GABA functioning, however, such as alcohol and benzodiazepines. Medications that boost the availability of GABA or mimic its effects at receptors may possess some clinical potential in treating addiction, but also have abuse liability.
The glutamate system and addiction
Authors: Nutt David J. , Nestor Liam J.
Published: October 2018

Glutamate is the primary excitatory neurotransmitter in the brain. Glutamate is involved in synaptic plasticity, particularly within dopamine systems of the brain that are involved in reward. Glutamate-dependent plasticity is involved in the development of substance addiction through its actions at NMDA receptors during long-term potentiation (LTP) related learning and memory processes. This plasticity within brain circuitry involved in learning and memory is sustained during substance abstinence and may provide a neural substrate for a vulnerability to addiction relapse. Medications that possess the efficacy to reduce glutamate tone in certain brain circuits may reduce craving, and ultimately, relapse in substance dependence. Further research is required, however, to show that the modulation of glutamate transmission in the brain confers clinical benefits in substance addiction.
The opioid system and addiction
Authors: Nutt David J. , Nestor Liam J.
Published: October 2018

The opioid system of the brain is the major target for opiate drugs such as morphine and heroin, and has been implicated in processes such as pain, stress and reward. Many of these effects take place at the mu opioid receptor (mOR), which is distributed throughout the brain. Significantly, genetic polymorphisms at the mOR may confer a greater dopamine response to the reinforcing effects of alcohol, and it has been suggested that addiction per se may be associated with alterations to the opioid system. There is evidence for the potential efficacy of mOR antagonists (e.g. naltrexone) in reducing drug and alcohol relapse, increasing treatment retention and attenuating the subjective effects of substances of abuse. Medications with partial agonist activity at the kappa opioid receptor (e.g. nalmefene) may also confer an additional clinical advantage by reducing binging following relapse.
Appetite hormones and addiction
Authors: Nutt David J. , Nestor Liam J.
Published: October 2018

Many of the same behavioural and brain disturbances observed in addiction are also seen in obesity and binge-eating disorder. This suggests that there are shared neural substrates between substance addiction and compulsive food consumption. Food intake and appetite are regulated by numerous appetite hormones that exert their effects through brain systems involved in reward sensitivity, stress, impulsivity, and compulsivity. There is now emerging evidence that appetite hormones (e.g. ghrelin, glucagon-like peptide-1, orexin) can modulate addictive behaviours (e.g. craving) and the intake of alcohol and drugs. Therefore, there is an emerging shift into a new field of testing drugs that affect appetite hormones and their receptors in the brain, and their use in regulating the brain mechanisms that lead to relapse in addiction disorders.
Treatment response and resistance in schizophrenia: principles and definitions
Authors: McCutcheon Robert , Correll Christoph U. , Howes Oliver , Kane John
Published: October 2018

Clear, accepted definitions of treatment resistance and response are needed so that clinical trials of treatments can be compared, and evidence can be meaningfully interpreted to inform clinical practice. In this chapter, we review the definitions of treatment response and resistance used in clinical trials, highlighting the variability in definitions used across studies, as well as a number of problems with the definitions used, including mixing treatment-intolerant patients with treatment-resistant patients and limited evaluation of the adequacy of treatment in many cases. The chapter then summarizes the work undertaken by the Treatment Response and Resistance in Psychosis working group to produce consensus guidelines and benchmarks to address these issues. Also reviewed are the principles underlying the concept of resistance developed by the working group. Finally, the chapter discusses the implications of these findings for clinical practice.
Maximizing response to first-line antipsychotics in schizophrenia
Authors: Smith Robert C. , Leucht Stefan , Davis John M.
Published: October 2018

The choice of first-line antipsychotic treatment for patients with schizophrenia should balance considerations of differential efficacy of antipsychotics against the relative risk of different side effects. In terms of efficacy, recent meta-analyses have shown that antipsychotics are not equivalent in efficacy. Clozapine, amisulpride, olanzapine, and risperidone show small to moderate, but statistically significant, differences, indicating greater efficacy compared to a number of other antipsychotics on some primary efficacy outcome measures. Amisulpride and cariprazine have the strongest evidence for greater efficacy for treating negative symptoms relative to other antipsychotics. In terms of side effects, clozapine and olanzapine have among the highest weight gain potential and amisulpride has more effects on QTc prolongation and prolactin elevation than other commonly used antipsychotics. Adjunctive treatment with an antidepressant drug may improve response in patients with schizophrenia who also have severe depressive or negative symptoms. For a patient with an inadequate response to an adequate dose and duration of the initial antipsychotic choice, switching to another antipsychotic with a different receptor profile may improve response, although evidence is limited. There is little evidence to support using doses above the therapeutic range other than in exceptional circumstances.
Epidemiology, impact, and predictors of treatment-resistant schizophrenia
Authors: Lally John , MacCabe James H.
Published: October 2018

Treatment-resistant schizophrenia (TRS) is a disabling psychotic disorder that affects approximately 30% of those diagnosed with schizophrenia. In a significant proportion (about 70%) of patients with TRS, their illness is treatment-resistant from onset (early or primary treatment resistance), whilst, in the remainder, treatment resistance develops during the course of illness (late or secondary treatment resistance). TRS is associated with reduced quality of life and increased social and economic burden. Multiple sociodemographic, clinical, and biological risk factors have been assessed in relation to TRS, but their interpretation remains limited owing to methodological variation, lack of replicability, and a paucity of longitudinal studies. This chapter will review the epidemiology, societal and economic burden, and risk factors associated with TRS.
Pharmacological management of treatment-resistant schizophrenia: fundamentals of clozapine
Authors: Yang Yvonne , Marder Stephen
Published: October 2018

Evidence from controlled clinical trials supports the prescribing of clozapine for patients with treatment-resistant schizophrenia (TRS). Early studies focused on severely ill TRS patients. More recent studies indicate that clozapine can be effective for patients who are relatively stable but are burdened by persistent psychotic symptoms. Clozapine treatment is associated with a substantial side effect burden, including sedation, orthostasis, weight gain, constipation, and seizures. In addition, because of a risk of potentially fatal agranulocytosis, clozapine patients require regular monitoring of their neutrophil count. Measuring clozapine plasma concentrations can be helpful in managing patients with severe side effects and those with an inadequate clinical response. A trial of clozapine should consist of a minimum duration of 12 weeks.
Introduction
Authors: Balboni Michael J. , Balboni Tracy A.
Published: October 2018

A spiritual sickness lies over American medicine. As an introduction to Hostility to Hospitality, this chapter depicts the sickness as a growing hostility within the patient–clinician relationship. Forms of this hostility are revealed by three paintings completed around the turn of the twentieth century that depict a depersonalizing relationship between patients and clinicians. The book’s motivation is to describe why spiritual care is avoided or neglected by clinicians within the context of serious illness and then to consider the large-scale cultural consequences of this divorce between medicine and spirituality/religion. In moving from empirical and sociological description to theological analysis and concluding with public policy considerations, the chapter proposes a new partnership model for medicine and spiritual traditions.
Spirituality and End-of-Life Outcomes
Authors: Balboni Michael J. , Balboni Tracy A.
Published: October 2018

A growing number of studies show prospective associations between patient spirituality and quality of life. Evidence suggests that as physical health worsens, spiritual health holds a central role in determining patient well-being. Spirituality may enable patients to endure the suffering that comes with advanced illness and dying. Growing evidence also indicates that treatment preferences, medical decisions, and medical utilization are shaped by patients’ religiosity and the level of spiritual support from the medical team and religious communities. Spiritual support from the medical system is associated with increased hospice use, decreased aggressive care, and cost differences in the final week of life. This suggests that medical system spiritual support is an essential component that lessens futile medical treatment near life’s end. Those clinicians who are proficiently “fluent” in engaging religious beliefs may be better able to influence patients in making medical decisions. National standards have begun to incorporate these results.
What Hinders Spiritual Care?
Authors: Balboni Michael J. , Balboni Tracy A.
Published: October 2018

Both patients and clinicians agree that spiritual care occurs infrequently. This chapter explores possible reasons why spiritual care is infrequently provided by clinicians by focusing on six hypotheses using empirical evidence from a Boston-based research study of patients, nurses, and physicians in the context of serious illness. Evidence from the study eliminates several hypotheses about why clinicians infrequently provide spiritual care. Most notably, the study found that clinicians who had not received spiritual care training had significantly higher odds of not providing spiritual care. These findings emphasize the importance of training as being a primary reason why clinicians infrequently provide spiritual care within serious illness.
Social Structures Separating Medicine and Religion
Authors: Balboni Michael J. , Balboni Tracy A.
Published: October 2018

The reasons that medicine and religion appear to be rightly separated are reinforced by plausibility structures, unstated cultural assumptions that legitimate socially held beliefs and practices, and socializing patients and medical professionals to keep medicine and spirituality discrete. Plausibility structures include the now-accepted belief that hospitals are spaces set apart for advanced technological interventions; that physicians are primarily scientists whose social authority to act is grounded primarily in the scientific method; and that the cultural repression of dying is in tension with religious sensibilities. The ethos within medicine striving to restore health and extend life is incongruent with the message of the world’s religions, which fundamentally acknowledge human mortality. To the degree that medicine is collectively controlled by ambitions to forestall death, it remains ambivalent toward social understandings that highlight either its limitations or the unavoidability of death. These widely accepted beliefs undergird a general acceptance of medicine’s separation from religion.
Defining Religion and Spirituality
Authors: Balboni Michael J. , Balboni Tracy A.
Published: October 2018

This chapter notes two general approaches, the substantive and functional, in how spirituality and religion may be conceptualized. A functional understanding is less focused on the specific content that comprises religion, such as the superhuman or the gods, and instead concentrates on the ultimate concern or greatest love of said religion. Within this functional approach, spirituality and religion are closely related but not identical. Spirituality refers to the immaterial connection between the lover and the object chiefly loved. Religion concerns the external structures that support and enable an ultimate concern or greatest love. Both conceptual approaches hold scholarly legitimacy, but functional understandings, unlike substantive definitions, open innovative ways within an increasingly pluralistic society to interpret the relationship of spirituality and religion within medicine, so that traditional “religious,” “spiritual but not religious,” and deeply “secular” persons may uncover shared values and common ground in the care of the sick.
The Sacramental Nature of Medicine
Authors: Balboni Michael J. , Balboni Tracy A.
Published: October 2018

There is an underlying structural bond between medicine and religious monotheism. There are shared assumptions, values, and institutional structures that create a deep underlying unity between these two spheres. There are five broadly shared connections between secular medicine and the monotheistic religions—especially akin to Jewish and Christian traditions—where medicine and religion mirror one another in values and structures. These five points of connection include sickness/sin, the role of the healing mediator, therapy, patient disposition, and the healing milieu. When the spheres of medicine and religion become overtly disconnected from one another as partners, as now is the case in secular medicine, medicine rises perilously to the level of a functional-like religion. While contemporary medicine attempts to be consciously neutral toward traditional religions, medicine’s internal structures mirror deeper religious concepts, in tension with secular interpretations.
Problematic Rapprochement Strategies
Authors: Balboni Michael J. , Balboni Tracy A.
Published: October 2018

Current rapprochement strategies for medicine and spirituality are in tension with three distinct constituencies: skeptics, spiritual generalists, and religious particularists. Each constituency needs to compromise without losing its core values. Skeptics need to reconsider partnership with religion. Skeptics would gain by having an alliance with the social force of religions, which may alone can resist expanding market and bureaucratic forces. Spiritual generalists should move away from insisting that generic spirituality be accepted by all while still having a place at the table to advocate for their particular view. Distancing the movement of spirituality and health from religion provides some short-term gains but will unlikely lead to medicine’s meaningful transformation. Religious particularists must embrace both a functional definition of religion and the importance of empirical research of spirituality and religion. While finding common ground between these diverse groups is challenging given our current social context, new strategies are necessary for rapprochement.
Structural Pluralism for Medicine and Religion
Authors: Balboni Michael J. , Balboni Tracy A.
Published: October 2018

A spirituality of immanence has privatized other spiritual traditions in the practice of medicine. This creates social structures that make it increasingly difficult for patients to receive spiritual care from within their own spiritual traditions. Structural pluralism identifies and challenges the hegemony of immanence by imagining an alternative way to practice medicine. This form of pluralism argues for an intermediate space for communal traditions to hold structural space within the deep practices of medicine, thus upholding the tradition-dependent nature of spirituality and spiritual care, maintaining that spirituality in medicine must protect religious freedom against all forms of spiritual coercion, and identifying an incremental and scientific manner to move from the structures of immanence to pluralism. This proposal calls for a gradual unfolding through scientific testing, trial, and public evaluation toward the common good to enhance spiritual care for patients facing serious illness without imposing religion on patients or clinicians.
Neurocircuitry of Affective, Cognitive, and Regulatory Systems
Authors: MacNamara Annmarie , Phan K. Luan
Published: October 2018

This chapter provides a review and synthesis of the neurocircuitry involved in affect and cognition and their interactions as it relates to regulatory functions. Cognition and emotion are considered together taking a more integrated, functional perspective. The chapter first gives an overview regarding structure and function of key brain regions, that is, prefrontal and cingulate regions, insula, and subcortical regions, as well as other temporal-parietal-occipital regions. Following this overview, the chapter proceeds with summarizing key neuroscientific findings as organized by cognitive processes and their relevance for emotion. The choice of processes reflects the key stages involved in responding to a stimulus, from the time of sensory input to behavioral response/output, namely perception, learning and memory central executive functions, cognitive appraisal, and reappraisal. The overall aim of the chapter is to provide a better understanding of cognitive-emotional interactions at the neurocircuit level.
Cognitive Neuroscience Approaches to Personality Disorders
Authors: Poppe Andrew , MacDonald III Angus W.
Published: October 2018

This chapter describes a cognitive neuroscience approach to understanding the psychological and neural processes that underlie personality and behavior. It explicates the utility of the cognitive neuroscience approach and the fundamental principles of the methods and how to interpret the findings. The chapter reviews the different neuroimaging tools and approaches that can be used to investigate brain structure and function. In doing so, it provides detailed information about what each method measures and how issues to consider when evaluating these measurements and their functional significance. The chapter provides the reader an appreciation of how understanding brain structure and function in vivo can serve as a bridge between molecular/genetic and symptom-based data to enrich the pathophysiology of personality disorders.
Minding the Emotional Thermostat
Authors: Denny Bryan T. , Ochsner Kevin N.
Published: October 2018

This chapter takes a social cognitive affective neuroscience approach to describe the processes and systems to give rise to emotion and the volitional control of emotion. It provides a detailed description of the processes that underlie the regulation of emotion. It introduces and synthesizes the brain structures involved in emotion processing and regulation. There is a particular focus on the role of the ventrolateral, dorsolateral and dorsomedial prefrtonal cortex, amgydala, ventral striatum and insula, and on cognitive strategies such as reappraisal. It provides a critical framework for understanding the underlying behavioral and neural basis for the affect dysregulation observed across personality disorders, and summarizes future directions for this area of investigation.
The Clinical Neuroscience of Impulsive Aggression
Authors: Lee Royce , Fanning Jennifer R. , Coccaro Emil F.
Published: October 2018

Aggression can be categorized into three subtypes: premeditated aggression, frustration-related aggression, and impulsive aggression (IA), which is the focus of this chapter. It first delineates the social information processing model of IA and its neurobiological underpinnings, with a special focus on ventral prefrontal-amygdala, frontostriatal, and frontoparietal circuits. In these circuits, structural as well as functional alterations have been associated with IA. A large body of basic and clinical research has examined the role of neurotransmitters (glutamate, GABA) and neuromodulators (monoamines and neuropeptides) in mediating IA. The important role of the monoamines dopamine, serotonin, norepinephrine, and acetylcholine in the mediation of different aspects of IA and the pharmacological potential resulting from these alterations are depicted in the second half of the chapter. The chapter concludes with an overview of the most important etiological factors.
The Neurobiology and Genetics of Schizotypal Personality Disorder
Authors: Rosell Daniel R. , Siever Larry J.
Published: October 2018

This chapter focuses on the neurobiology of schizotypal personality disorder (SPD) as well as schizotypy or attenuated schizophrenia-spectrum traits present among the general population, as opposed to clinical cohorts. It can be assumed that a better understanding of the neurobiology of SPD will hopefully lead to enhancements of the diagnosis and treatment of this complex, impairing, yet understudied, condition and the assessment of novel therapeutics. The chapter first characterizes the SPD construct, then turns to the genetics and development of SPD, followed by a review of studies employing nonimaging, laboratory measures. Then anatomical, functional, and neurochemical imaging findings are discussed.
The Neurobiology of Antisocial Personality Disorders Focusing on Psychopathy
Authors: Baliousis Michael , Khalifa Najat , Völlm Birgit
Published: October 2018

This chapter reviews the evidence base for a range of biological factors in antisocial personality disorder (APD) and psychopathy in adults (there is a substantial evidence base for children and adolescents with antisocial behavior as well, though the inclusion of these studies is outside our scope), including genetic factors, neurophysiological and neuropsychological findings, structural and functional brain changes, and transmitter and hormone aberrations. In order to summarize the evidence, this chapter systematically reviews others’ reviews and meta-analyses in the field but also refers to individual studies of particular relevance. The chapter focuses more on psychopathy than on APD because it provides a more narrow and less controversial concept, at least in relation to its use in research.
Established and Novel Pharmacological Approaches to the Treatment of Personality Disorders
Authors: Schulz S. Charles , Friedel Robert O.
Published: October 2018

In the past few decades, the widely held belief of personality disorder patients being unresponsive to medication has been challenged. This chapter first reviews the current knowledge on medication for patients with personality disorders and then considers a number of novel pharmacological approaches that may yield additional beneficial results in the treatment of these disorders. It utilizes the neuroscience-based nomenclature for psychotropic agents, in which the presumptive modes and mechanisms of action of each drug form the basis of the nomenclature. A special emphasis of the chapter is laid on the role of clozapine in the treatment of personality disorders as well as new findings in the areas of pharmacogenetics and epigenetics.
Conclusions and Future Directions
Authors: Schmahl Christian , Phan K. Luan , Friedel Robert O.
Published: October 2018

This chapter provides an overarching review of the current state of personality disorder research, addresses some of the many gaps that currently exist in the literature where more research is needed, and provides recommendations for the field’s future directions. It incorporates a discussion on the ongoing controversy over whether personality disorders are best suited to a dimensional or categorical diagnostic model. It concludes with a review of several promising studies that examine potential new treatment approaches, which warrant further investigation. Topics covers include the neurobiology of personality disorder, research in the area, future directions for research, a dimensional diagnostic model, and new treatment approaches.
The history
Authors: Thomas James , Monaghan Tanya , Thiagarajan Prarthana
Published: October 2018

History taking

Presenting complaint (PC)

Past medical history (PMH)

Drug history (DHx)

Allergies and reactions

Alcohol

Smoking

Family history (FHx)

Social history (SHx)

Systematic enquiry (SE)

Sexual history

The elderly patient
Practical procedures
Authors: Thomas James , Monaghan Tanya , Thiagarajan Prarthana
Published: October 2018

Using this chapter

Infiltrating anaesthetic agents

Hand hygiene

Consent

Aseptic technique

Subcutaneous and intramuscular injections

Intravenous injections

Venepuncture

Sampling from a central venous catheter

Arterial blood gas (ABG) sampling

Peripheral venous cannulation

Femoral venous catheter insertion

Central venous access: internal jugular vein

Central venous access: subclavian vein

Central venous access: ultrasound guidance

Intravenous infusions

Arterial line insertion

Fine needle aspiration (FNA)

Lumbar puncture

Male urethral catheterization

Female urethral catheterization

Basic airway management

Oxygen administration

Peak expiratory flow rate (PEFR) measurement

Inhaler technique

Non-invasive ventilation

Pleural fluid aspiration

Pneumothorax aspiration

Chest drain insertion (Seldinger)

Recording a 12-lead ECG

Carotid sinus massage

Vagal manoeuvres

Temporary external pacing

DC cardioversion

Pericardiocentesis

Nasogastric tube insertion

Ascitic fluid sampling (ascitic tap)

Abdominal paracentesis (drainage)

Sengstaken–Blakemore tube insertion

Basic interrupted suturing

Cleaning an open wound

Applying a backslab

Manual handling
Colorectal cancer
Authors: Cassidy Jim , Bissett Donald , Spence OBE Roy A. J. , Payne Miranda , Morris-Stiff Gareth , Sibtain Amen
Published: October 2018

Breast cancer reviews the epidemiology and aetiology of this malignancy, with particular attention to the genetics underlying familial breast cancer, its pathology along with its receptors, oestrogen receptor (ER), the growth factor receptor HER2, and epidermal growth factor receptor (EGFR), and the bearing these have on treatment and prognosis. The benefits of breast cancer screening in the population and families at higher risk are discussed. Presenting symptoms and signs are followed by investigation including examination, bilateral mammography, and core biopsy of suspicious lesions. Management of non-invasive in situ disease is considered. Invasive breast cancer is staged according to TNM guidelines. Early breast cancer is defined, managed frequently by breast conserving surgery and sentinel node biopsy from the axilla. A positive sentinel node biopsy requires clearance of the axilla. Larger lesions may require mastectomy. Breast radiotherapy is indicated after breast conserving surgery. Following surgery, the risk of systemic micrometastatic disease is estimated from the primary size, lymph node spread, and tumour grade. Adjuvant chemotherapy improves treatment outcome in all but very good prognosis premenopausal breast cancer, and intermediate or poor prognosis postmenopausal breast cancer. This is combined with trastuzumab in HER2 positive disease. Adjuvant endocrine therapy is recommended for all ER positive breast cancer, tamoxifen in premenopausal, aromatase inhibitors in postmenopausal women. Neoadjuvant chemotherapy may be used in large operable breast cancers to facilitate breast conserving surgery. Locally advanced breast cancer is defined, its high risk of metastatic disease requiring full staging before treatment. Systemic therapy is often best first treatment, according to receptor profile. Metastatic breast cancer although incurable can be controlled for years using endocrine therapy, chemotherapy, trastuzumab, palliative radiotherapy, and bisphosphonates as appropriate. Male breast cancer is uncommon, but management similar.
Usefulness of guideline recommendations for prognosis in patients with candidemia
Authors: Cuervo Guillermo , Garcia-Vidal Carolina , Puig-Asensio Mireia , Merino Paloma , Vena Antonio , Martín-Peña Almudena , Montejo José Miguel , Ruiz Alba , Lázaro-Perona Fernando , Fortún Jesús , Fernández-Ruiz Mario , Suarez Ana Isabel , Castro Carmen , Cardozo Celia , Gudiol Carlota , Aguado José María , Paño Jose Ramón , Pemán Javier , Salavert Miquel , Garnacho-Montero José , Cisneros José Miguel , Soriano Alex , Muñoz Patricia , Almirante Benito , Carratalà Jordi ,   for the REIPI, the GEMICOMED (SEIMC) and the Spanish CANDI-Bundle Group
Published: October 2018

We aimed to analyze whether the lack of inclusion of specific recommendations for the management of candidemia is an independent risk factor for early and overall mortality. Multicenter study of adult patients with candidemia in 13 hospitals. We assessed the proportion of patients on whom nine specific ESCMID and IDSA guidelines recommendations had been applied, and analyzed its impact on mortality. 455 episodes of candidemia were documented. Patients who died within the first 48 hours were excluded. Sixty-two percent of patients received an appropriate antifungal treatment. Either echinocandin or amphotericin B therapy were administered in 43% of patients presenting septic shock and in 71% of those with neutropenia. Sixty-one percent of patients with breakthrough candidemia underwent a change in antifungal drug class. Venous catheters were removed in 79% of cases. Follow-up blood cultures were performed in 72% of cases. Ophthalmoscopy and echocardiogram were performed in 48% and 50% of patients, respectively. Length of treatment was appropriate in 78% of cases. Early (2–7 days) and overall (2–30 days) mortality were 8% and 27.7%, respectively. Inclusion of less than 50% of the specific recommendations was independently associated with a higher early (HR = 7.02, 95% CI: 2.97–16.57; P < .001) and overall mortality (HR = 3.55, 95% CI: 2.24–5.64; P < .001). In conclusion, ESCMID and IDSA guideline recommendations were not performed on a significant number of patients. Lack of inclusion of these recommendations proved to be an independent risk factor for early and overall mortality.
The Facility-Level HIV Treatment Cascade: Using a Population Health Tool in Health Care Facilities to End the Epidemic in New York State
Authors: Ikeda Daniel J , Hollander Leah , Weigl Susan , Sawicki Steven V , Belanger Daniel R , West Nova Y , Brey Magnani Nanette , Wells Christopher G , Gordon Peter , Morne Johanne , Agins Bruce D
Published: October 2018

Background

The HIV treatment cascade is a tool for characterizing population-level gaps in HIV care, yet most adaptations of the cascade rely on surveillance data that are ill-suited to drive quality improvement (QI) activities at the facility level. We describe the adaptation of the cascade in health care organizations and report its use by HIV medical providers in New York State (NYS).

Methods

As part of data submissions to the NYS Department of Health, sites that provide HIV medical care in NYS developed cascades using facility-generated data. Required elements included data addressing identification of people living with HIV (PLWH) receiving any service at the facility, linkage to HIV medical care, prescription of antiretroviral therapy (ART), and viral suppression (VS). Sites also submitted a methodology report summarizing how cascade data were collected and an improvement plan identifying care gaps.

Results

Two hundred twenty-two sites submitted cascades documenting the quality of care delivered to HIV patients presenting for HIV- or non-HIV-related services during 2016. Of 101 341 PLWH presenting for any medical care, 75 106 were reported as active in HIV programs, whereas 21 509 had no known care status. Sites reported mean ART prescription and VS rates of 94% and 80%, respectively, and 60 distinct QI interventions.

Conclusions

Submission of facility-level cascades provides data on care utilization among PLWH that cannot be assessed through traditional HIV surveillance efforts. Moreover, the facility-level cascade represents an effective tool for identifying care gaps, focusing data-driven improvement efforts, and engaging frontline health care providers to achieve epidemic control.
QTLs for Resistance to Fusarium Ear Rot in a Multiparent Advanced Generation Intercross (MAGIC) Maize Population
Authors: Butrón A. , Santiago R. , Cao A. , Samayoa L. F. , Malvar R. A.
Published: October 2018

Alternative approaches to linkage and association mapping using inbred panels may allow further insights into loci involved in resistance to Fusarium ear rot and lead to the discovery of suitable markers for breeding programs. Here, the suitability of a maize multiparent advanced-generation intercross population for detecting quantitative trait loci (QTLs) associated with Fusarium ear rot resistance was evaluated and found to be valuable in uncovering genomic regions containing resistance-associated loci in temperate materials. In total, 13 putative minor QTLs were located over all of the chromosomes, except chromosome 5, and frequencies of favorable alleles for resistance to Fusarium ear rot were, in general, high. These findings corroborated the quantitative characteristic of resistance to Fusarium ear rot in which many loci have small additive effects. Present and previous results indicate that crucial regions such as 210 to 220 Mb in chromosome 3 and 166 to 173 Mb in chromosome 7 (B73-RefGen-v2) contain QTLs for Fusarium ear rot resistance and fumonisin content.
An uncommon cause of vision loss
Authors: Glover Julie M. , Casmaer Monica L. , April Michael D.
Published: October 2018

Leber hereditary optic neuropathy (LHON) is a rare mitochondrial genetic disorder characterized by painless acute or subacute vision loss that develops during adolescence. Clinicians should know how to identify potential LHON and when to refer patients to a neuro-ophthalmologist for diagnosis and treatment. This case highlights the value of a thorough family history in ED patients.
Common causes of congenital stridor in infants
Authors: Clark Christine M. , Kugler Kathryn , Carr Michele M.
Published: October 2018

Stridor is a high-pitched respiratory sound that signals upper airway obstruction. It can be encountered by clinicians in a variety of clinical settings and requires a team-based, interdisciplinary approach. Early recognition is crucial, as the differential diagnosis can be broad, and causes range from benign to life-threatening. This article reviews the most commonly encountered causes of chronic congenital stridor in infants, focusing on the diagnostic approach, pathophysiology, clinical presentation, and management strategies.
HPV Vaccination does not Change Adolescent Sexual Behaviors
Authors: Mechcatie Elizabeth , Rosenberg Karen
Published: October 2018

According to this study:

Enactment of state legislation designed to increase use of the human papillomavirus vaccine does not lead to an increase in risky sexual behaviors in U.S. adolescents.
Fixing America's Health Care System
Authors: Brown Theresa
Published: October 2018

In The Healing of America, journalist T.R. Reid considers what other countries’ health care systems can teach us.
Enhancing communication skills with additional language acquisition
Authors: Lundgren Laura
Published: October 2018

Miscommunication in a healthcare setting can be deadly, and language barriers between nurses and their patients can be a major factor. Having the ability to communicate with non-English-speaking patients strengthens communication and trust between a patient and nurse and helps prevent medical errors. This article discusses why nurses should pursue this valuable skill and how to start.