bluuebunny/crossref_metadata_2025_split huggingface dataset:
Typical and Atypical Antipsychotics in Adolescent Schizophrenia: Efficacy, Tolerability, and Differential Sensitivity to Extrapyramidal Symptoms
Authors: Lewis Ralph 
Published: January 2017

Objective: To review the existing literature on the efficacy and tolerability of antipsychotics for adolescent psychosis. The review focuses in particular on literature regarding adverse effects that are thought to have an increased incidence in young patients and on the possible neurobiological bases for such differential sensitivity. Method: Pertinent studies were sought using Medline searches, supplemented by selected bibliographies, and reviewed. Results: There is a relative paucity of research in this area; in particular, well-controlled trials are lacking. The existing literature suggests fairly good efficacy of both typical and atypical antipsychotics in the treatment of psychotic disorders in children and adolescents. However, the incidence of certain side effects, particularly extrapyramidal symptoms (EPS), is found to be higher in young patients compared with adults. Positron emission tomography (PET) receptor studies in adults have demonstrated that the incidence of EPS is related to dose-dependent dopamine type-2 (D2) receptor occupancy and that there is a significant relationship between the number of these receptors and age. Conclusions: Improved tolerability is leading to the increasing use of atypical antipsychotics for adolescent patients, though these new drugs do have specific adverse effects of their own. There is a need for more controlled studies of atypical antipsychotics in children and adolescents. In particular, dose-finding studies are needed to determine the optimal dose range to produce the greatest improvement with the least side effects for each of these new drugs.
Attention-Deficit Hyperactivity Disorder Subtypes and Comorbid Disruptive Behaviour Disorders in a Child and Adolescent Mental Health Clinic
Authors: Lalonde Justine , Turgay Atilla , Hudson James I 
Published: January 2017

Objective: To assess demographic characteristics and patterns of comorbid disruptive behaviour disorders (oppositional defiant disorder [ODD] or conduct disorder [CD]) in subtypes of attention-deficit hyperactivity disorder (ADHD). Method: One hundred youths consecutively referred to a community child and adolescent mental health clinic and subsequently diagnosed with ADHD by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria were evaluated. The diagnosis was made by a child psychiatrist and was based on information from physicians, parents, teachers, and diagnostic interviews with the youths and their parents. Results: The major findings were: 1) ADHD combined (C) type was diagnosed in 78% of the subjects, while 15% had inattentive (I) type and 7% had hyperactive—impulsive (HI) type; and 2) patterns of comorbid disruptive behavioural disorders significantly differed among subtypes. Specifically, subjects with the I type showed lower rates of comorbid ODD than those with the C type (33% and 85%; P < 0.001) and HI type (33% and 100%; P = 0.005); subjects with the HI type displayed a higher prevalence of CD than those with the I type (57% and 0%; P = 0.005) and C type (57% and 8%; P = 0.003). These results should be considered tentative because the reliability of the diagnostic procedures was not formally assessed and the number of subjects in the I and HI groups was small. Conclusion: ADHD subtypes showed significant differences in the distribution of comorbid disruptive behaviour disorders. These results support the utility of ADHD subtypes but should be replicated with a larger sample of I and HI type subjects using more rigorous diagnostic methods.
Adolescents on Neuroleptic Medication: Is This Population at Risk for Tardive Dyskinesia?
Authors: McDermid Stephanie A , Hood Jane , Bockus Sandra , D'Alessandro Enzo 
Published: January 2017

Objective: To assess the incidence of tardive dyskinesia (TD) in a sample of adolescents treated with neuroleptic medication and to identify the presence of any risk factors for TD within the affected group. Method: A retrospective chart review was conducted for 40 cases. The Abnormal Involuntary Movement Scale (AIMS) was used to measure side effects from medication at 6-month intervals over 2 years. Drug exposure was converted to chlorpromazine (CPZ) equivalents and the presence of risk factors for TD, such as a diagnosis of affective disorder, medication noncompliance, early age of illness onset, and concomitant antiparkinsonian medication, was also noted. Results: Of the 40 cases reviewed, 2 patients (5%) met diagnostic criteria for TD, and another 5 patients (12.5%) showed symptoms of TD. Conclusions: TD is a serious risk at any age. Medication noncompliance, early age of illness onset, and concomitant use of antiparkinsonian medication may increase susceptibility to TD and should be carefully monitored.
Mental Health Legislation and the Right to Appropriate Treatment
Authors: O'Reilly Richard L 
Published: January 2017

Objective: To demonstrate how mental health legislation and its implementation can detract from a patient's “right to health.” Method: The author surveyed colleagues working at the London and St Thomas Psychiatric Hospitals about cases where the structure or implementation of the Mental Health Act in Ontario (1) impeded the provision of good psychiatric care. Results: Four clinical vignettes illustrate specific problems; possible solutions to these difficulties are suggested. Conclusion: Physicians must remain vigilant in their role as advocates for patients' right to appropriate treatment.
Optimal Haloperidol Dosage in First-Episode Psychosis
Authors: Zhang-Wong J , Zipursky RB , Beiser M , Bean G 
Published: January 2017

Objective: To determine optimal doses of haloperidol for the treatment of a first episode of psychosis. Method: A 4-week prospective controlled clinical trial with “optimal dose” defined as the dose at which either of the following occurs: 1) significant improvement, defined as a 15% or greater decrease in scores on the Positive And Negative Syndrome Scale (PANSS), or 2) the onset of extrapyramidal symptoms. Beginning with 2 mg daily, haloperidol was increased weekly to 5 mg, 10 mg, and finally 20 mg daily until either 1) or 2) occurred. Results: Optimal doses for the 36 subjects were 2 mg daily for 15 subjects, 5 mg daily for 11, 10 mg daily for 7, and 20 mg daily for 3. On average, subjects whose optimal dose was 2 mg daily showed the greatest improvement. Among the 27 subjects evidencing clinical response to treatment, 20 had plasma haloperidol levels below 5 ng/ml. Conclusion: Many people suffering a first psychotic episode respond to haloperidol doses well below levels in common use.
The Impact of Primary Mental Health Care in a Prison System in Brazil
Authors: Taborda José GV , Bertolote José M , Cardoso Rogério G , Blank Paulo 
Published: January 2017

Objective: To analyze the impact of a psychiatric service in a prison general hospital that refers prisoners with mental disorders to a separate forensic psychiatric hospital (FPH). Method: Analysis of data on prison population and referrals to the FPH. Results: Despite a 10.9% increase in the overall prison system population over 3 years, referrals from the prison general hospital with the new psychiatric service to the FPH were reduced by 36.5%, whereas referrals from other prisons increased by 120.4%. Conclusion: Our results demonstrate the efficiency of the new primary health care approach.
Psychiatric Aspects of Sexual Abuse Involving Persons with Developmental Disabilities
Authors: McCreary Bruce D , Thompson John 
Published: January 2017

Objective: To consider psychiatric issues that relate to the prevention and management of sexual abuse involving persons with developmental disabilities as either abusers or victims. Method: Seven case descriptions illustrate the clinical challenges raised by allegations of sexual abuse. Results: Mental disorders and communication problems often coexist with the cognitive impairment that is primary in developmental disabilities. Pedophilic behaviour prompts allegations of abuse, and posttraumatic stress disorder often follows abuse. Difficulties communicating with others may preclude the detection of abuse or normal legal proceedings once an allegation is made. Conclusions: Psychiatric expertise applied both directly and indirectly through others is relevant in the prevention of sexual abuse and the management of those with developmental disabilities who are abusers or abused.
Prevalence of Problem Gambling: A Replication Study 7 Years Later
Authors: Ladouceur Robert , Jacques Christian , Ferland Francine , Giroux Isabelle 
Published: January 2017

Objectives: To investigate the relationship between availability of gambling activities and participation in gambling, maximum amount of money lost in 1 day to gambling, and number of pathological gamblers. Method: Two random samples (1002 and 1257 adults) were surveyed 7 years apart using the South Oaks Gambling Screen to identify pathological gamblers. Results: Seven years later, significantly more people reported having gambled, and the number of pathological gamblers had increased by 75%. Conclusions: These findings support the hypothesis that increases in the availability of gambling are related to increases in the number of problem gamblers.
Attention-Deficit Hyperactivity Disorder in Children and Youth: A Quantitative Systematic Review of the Efficacy of Different Management Strategies
Authors: Klassen Anne , Miller Anton , Raina Parminder , Lee Shoo K , Olsen Lise 
Published: January 2017

Objective: To obtain estimates of the relative efficacy of 3 main treatment strategies for attention-deficit hyperactivity disorder (ADHD) in children and youth (age < 18 years). Methods: Design: quantitative systematic review of randomized trials. Subjects: 999 patients with ADHD from 26 randomized trials. Interventions: medications alone, behavioural interventions alone, and a combination of these 2 modalities. Main outcome measure: differences in scores between treatment groups on commonly used teacher- and parent-completed behaviour rating scales. Results: Medication-only therapy was efficacious in ADHD. Behavioural therapies used alone appeared not to be efficacious in ADHD. Combination therapy was more efficacious than placebo or no treatment for parent but not teacher ratings, not more efficacious than drug therapy alone, and more efficacious than behavioural treatments alone based on parent but not teacher ratings. Conclusion: Though stimulant medications were found to be an effective treatment strategy for ADHD in children and youth, it proved difficult to assess the relative benefits of behavioural interventions alone and combined medication and behavioural therapy because of the paucity of treatment studies other than medication-only treatment studies and heterogeneity of various kinds that exist in relation to ADHD studies and treatments.
Appropriateness of Psychostimulant Prescription to Children: Theoretical and Empirical Perspectives
Authors: Miller Anton 
Published: January 2017

Objectives: 1) To consider study designs for evaluating how appropriately stimulant medications are prescribed to children. 2) To investigate appropriateness by seeking evidence of consensus around how stimulant management should be undertaken, collecting and reviewing evidence of actual physician practice in relation to use of stimulants, and evaluating the closeness of fit between recommended and actual practice. Method: Electronic databases and other published and unpublished material were searched for the decade 1987–1997 to identify 1) authoritative recommendations for medical management of attention-deficit hyperactivity disorder (ADHD) and 2) surveys of physician practice. Available information was analyzed qualitatively for commonalities and trends and for concordance between recommendations and practice. Results: Despite differences in emphasis between experts, common themes were identifiable regarding prerequisites and follow-up for use of stimulants. Overall, it was rare to find physician practice in accordance with expert recommendations more than 70% of the time, suggesting that management may be suboptimal in at least 30% of children treated with medication for ADHD. Across surveys, consistent differences appear in physician practice patterns related to practice type. Management by specialist consultants approximates standards recommended by experts, while management by primary care practitioners diverges from these standards. Conclusions: There are grounds for concern about the quality and appropriateness of medical management for children with ADHD. The methodology used in this study holds promise for wider application, with planning and refinement. There is a need to find ways to improve care for children with ADHD provided by primary care physicians.
A Study of Time-Dependent Operating Room Fees and How to save $100 000 by Using Time-Saving Products
Authors: Shippert Ronald D. 
Published: January 2017

Problem/Issue: Product costs are a portion of the annually increasing costs of medical care. With diligent analysis of product costs, including the cost of time to use the product, the surgeon can reduce these spiraling costs. The purpose of this study was to provide the surgeon with the necessary information to make informed decisions about time- and cost-efficient products. Materials and Methods: This study involved phoning, faxing, or e-mailing hospitals and anesthesia groups across the United States to obtain time-dependent costs in the hospital operating room. Operating room fees charged by the hospital and anesthesiologist professional fees are included. Various products were then relatively compared with the time needed to prepare, use, or apply the product. Time and cost factors were then compared in order to ascertain the most time- and cost-effective products. Findings: The findings revealed an average of $62 per minute (rounded to the closest dollar) for the hospital operating room fee (range $21.80–$133.12) and $4 per minute for the anesthesiologist professional fee (range $2.20–$6.10), with a total of $66 per minute. This figure represents a marked increase from the 1991 rate of $20 per minute. Generalizations from this study indicate that time-cost efficiency is seen more so in kits (trays) than in nonkits and more so in disposables than in durables. Products that require fewer people are more time-cost efficient than those that require more people, and products that require fewer steps are more time-cost efficient than those that require more steps. Specific findings included time and cost dominance for the following products: staples over sutures, direct-current cautery over alternating-current cautery, syringes over Dermajet or Madajet, MagneSplint over suturing the nasal septum, aluminum-Velcro or aluminumfoam Denver Splint and Xomed Bridgemaster over any of the polypropylene heat-sensitive splints, Rhino Rocket and Merocel over Vaseline gauze, Brennan RhinoCath over manual blood removal, 1-piece Biplane liposuction cannulas over any 2-piece type, Doyle ear-dressing kit over component parts, Dale nasal dressing over component parts, preformed implants over manual forming, and Denver Splint kits over component parts. Conclusions: Each hospital or private suite will have different charges, and the range of product choices for each surgeon will be different. However, the principle is the same: If you save time, you will save money. In addition to the monetary benefit, the patient will be safer and receive less anesthesia, and the surgeon will have more time for his or her own social or professional life. Each surgeon should analyze the product choices and choose those products that will deliver quality care in less time. To save more than $100 000, the surgeon has to save only approximately 7 minutes per case on 250 cases.
Kinematic Comparison of Spontaneously Generated Blinks and Voluntary Blinks in Normal Adult Subjects
Authors: Baker Robert S. , Abou-Jaoude Edward S. , Napier Sharon M. 
Published: January 2017

Purpose: Spontaneous and voluntary blinks share a common final neuromuscular pathway but have totally different purposes and have come under different evolutionary pressures. The purpose of this study is to compare quantitative blink kinematics (down-phase duration, amplitude, peak velocity, and lid-closure duration) of spontaneously generated blinks with voluntary blinks in normal adults. Methods: Spontaneous and voluntary (tone generated) blinks of the right eye of 7 subjects were studied by a modified scleral search coil technique. Automated analysis of each blink kinematic was performed and statistical analysis of pooled data was undertaken. Results: All kinematics of voluntary blinks were greater than those of spontaneous blinks: duration (77.6 ± 10.0 milliseconds) was 17.6% longer, amplitude (43.1 ± 7.9°) was 40.8% larger, peak velocity (1288.6 ± 358.5°/ms) was 47.3% faster, and mean lid-closure duration (13.4 ± 4.7 milliseconds) was 61.4% longer (P < .001 in all cases). Conclusion: Kinematics of voluntary and spontaneous blinks are significantly different, reflecting their different supranuclear control. This quantitative study confirms previous qualitative observations and clearly separates these categories of eyelid movement as distinct, with spontaneous blinks serving a purely physiologic function and voluntary blinks being a part of facial expressivity.
Incidental Finding of Restylane in a Deep Mohs Micrographic Surgical Margin
Authors: Lane Joshua E. 
Published: January 2017

Objective: Soft tissue augmentation is a mainstay of minimally invasive facial rejuvenation. Hyaluronic acid fillers, such as Restylane, have been used extensively for this purpose. Because it is so extensively used, Mohs surgeons should be aware that it may appear when surgical margins are histologically examined during micrographic surgery. Methods: Case report. Case Presentation: A 54-year-old woman referred for treatment of a squamous cell carcinoma of the left upper cutaneous lip. She was treated successfully with Mohs micrographic surgery. Restylane was identified as acellular blue foreign material in the hematoxylin-eosin stained frozen sections obtained from the biopsy. Subsequent inquiry to the patient revealed that Restylane had been injected 4 months previously. Discussion: Restylane is a hyaluronic acid filler that is commonly used to improve facial lines and rhytides. The clinical and histologic duration of Restylane is thought to approximate 6 to 9 months. It is important to recognize that when intraoperative frozen sections are examined, they may contain unexpected histologic features given the expanded use of cosmetic filling agents. Conclusion: It would be reasonable for Moh's surgeons to become aware of the different cosmetic filling agents and their histologic appearance and to include on presurgical questionnaires a question about past treatment with cosmetic fillers to avoid unexpected histologic findings.
The Use of Infrared Coagulation in Hair Transplant and Scalp Reduction Surgery
Authors: Hitzig Gary S. , Schwinning John P. , Handler Seymour L. 
Published: January 2017

The infrared coagulator, a spin off of laser technology, has been used for more than a decade, first in Europe and then in the United States, for the in-office elimination of first and second degree hemorrhoids. Even more recently, it has been employed in the treatment and removal of unwanted tattoos. This device has been FDA approved for both anorectal and dermatologic applications. Within the last year, we have conducted a thorough study in our practice of the use and comparison of electrocoagulation, radiosurgical coagulation, and infrared coagulation during both hair transplantation and scalp reduction surgery. The infrared coagulator with its multiple-sized tips and pinpoint accuracy has proven to be superior (especially in a wet field) in providing excellent hemostasis, allowing minimal blood loss, and in allowing the clearest visual field in performing both hair transplant and scalp reduction surgery. Because no ground or antenna plates are necessary for the use of the device, it is extremely safe and effective and thus minimizes both patient risk and electrical shock. Its excellent effect in a wet field (it's used in bleeding hemorrhoids) as well as its uncumbersome size and versatility, makes it the ideal instrument for use during hair transplant and scalp reduction surgery. The device has been tested in the treatment of arteriovenous fistulas in the donor area of the scalp as well and has proved to be quite safe and effective. This paper presents a study encompassing 110 patients undergoing either hair transplant or scalp reduction surgery. Each different modality of coagulation is utilized for the various transplant or scalp reduction sessions on the same patient. Comparisons of effectiveness and postoperative complications are made. Detailed results and photographs are presented.
Optical Methods To Measure Shape and Size
Authors: Boone P.M. 
Published: January 2017

A number of methods are available to quantify exterior size and shape of living and non-living objects. Relevant items for dentistry are the exterior of face and skull and the surface of dental casts. To the best of our knowledge, dentitions have not yet been measured in situ. The optical methods using incoherent light are mechanical sensing of casts, visual stereometry (on the subject or on stereophotographic pairs), moire techniques, and optical-sensor morphometry. It will be shown that the three latter systems in fact rely on the same physical principles, although they involve quite different technologies. On the other hand, coherent optical techniques, such as holography and contouring holographic interferometry, are presented. The basic principles of the different techniques are shown, and their main features in relation to applications to the dental object discussed. Main features include: resolving power, range, time needed for a measurement, requirements for the surface of the object, and ease of selection and collection of data. Examples of methods from the literature and from work by the author are given.
Piezoelectric Polymer Transducers
Authors: Davis G.T. 
Published: January 2017

Poly(vinylidene fluoride) (CH2-CF2)n is a tough, flexible polymer readily available in the form of thin film which can be made piezoelectric by the temporary application of a high electric field. The areas of the film which become piezoelectric can be controlled to be the areas where metal electrodes are evaporated onto the film. The same electrodes and associated leads are subsequently used to detect the electric charge generated by the application of pressure to the active area. Such films may have applications in the measurement of occlusal forces. Many of the problems that might be encountered in an occlusal gauge have been addressed separately in other applications. For example, polymer transducers less than 100 μm thick have been developed and tested for measuring the nip pressure on an intaglio printing press. Piezoelectric polymer gauges have been successfully encased in a protective layer of another polymer to prevent the sharp edges of sand particles from breaking through the piezoelectric film. Transducer films with an array of active areas have been produced with electrical leads from each area so that the source of the signal can be traced. Electrode patterns have usually been established by evaporation of metal through a mask, but silk-screening a conductive ink has also been shown to be an effective means of defining which areas of the film are to be made piezoelectric. Finally, poly(vinylidene fluoride) has been shown to retain 80% of its initial activity after 1000 hours at 100°C, and it is unaffected by moisture. Therefore, if necessary, gauges to be used in dentistry could be subjected to steam sterilization for repeated use. The physical properties of such polymer films and examples of their use in pressure transducers are reviewed with the intent of stimulating interest in development of a system useful for measuring occlusal forces.