bluuebunny/crossref_metadata_2025_split huggingface dataset:
Genetics of Pediatric Psychiatric Disorders
Authors: De Rubeis Silvia , Trelles M. Pilar , Buxbaum Joseph D. 
Published: December 2017

Abstract
With the advent of genome-wide methods to identify genes and loci contributing to risk for complex disorders, there has been an explosion of findings in pediatric psychiatric disorders. We provide a brief primer on recent genome-wide approaches and on key concepts that are important for the understanding of genetic findings in the field of psychiatry, with a focus on pediatric psychiatric disorders. We summarize how common and rare genetic variation, associated with either modest or high risk, contributes to the risk architecture of pediatric psychiatric disorders. As we review these approaches and concepts, we highlight salient examples from these disorders and connect to other neurobiological and clinical concepts discussed in other chapters in this section. This overview also provides background to clinical genetic reports, which are now being used more and more frequently for unexplained neurodevelopmental disorders.
Animal and Cellular Models of Pediatric Psychiatric Disorders
Authors: Drapeau Elodie , Harony-Nicolas Hala , Crawley Jacqueline N. 
Published: December 2017

Abstract
The study of childhood psychiatric disorders is especially challenging, not only because of the difficulties in obtaining relevant human samples but also because of ethical considerations regarding the ability of children to provide informed consent. Models that can be experimentally manipulated are therefore indispensable to study those disorders. Traditionally, biological psychiatry research has extensively employed animal models and characterizations of rodent behavior. More recently, induced pluripotent stem cells (iPSCs), and induced differentiation of iPSCs into different types of brain cells have offered new alternative strategies to elucidate mechanisms underlying cellular processes. Regardless of how they are created, optimal models should demonstrate face validity, construct validity, and predictive validity to be considered most relevant. This chapter highlights the major animal and cellular models currently used in the research of childhood-onset psychiatric disorders.
Neurobiology of Attention Deficit Hyperactivity Disorder
Authors: Faraone Stephen V. , Bhide Pradeep G. , Biederman Joseph 
Published: December 2017

Abstract
Attention deficit hyperactivity disorder (ADHD) is a prevalent, early-onset and persistent disorder of inattention, hyperactivity, and impulsivity. The mechanisms of action of ADHD medications, neuroimaging studies, and studies of monoamine systems and animal models suggest that dysregulation of catecholaminergic neurotransmission in cerebellar-corticostriatal circuits plays a key role in the pathophysiology of ADHD. The efficacy of ADHD medications likely arises from their differing profile of effects on (a) dopaminergic and noradrenergic systems and (b) the localization of these effects in prefrontal cortex and striatum. ADHD has a very high heritability, and although molecular genetic studies have found no causal common DNA variants yet, they have found strong evidence that rare duplications and deletions are risk factors for ADHD. Environmental risk factors, especially those that impact early neurodevelopment (i.e., exposure to cigarette smoking and alcohol during pregnancy), also influence susceptibility to ADHD.
Novel Approaches for Treating Pediatric Psychiatric Disorders
Authors: Prasad Supritha , Cook Edwin H. 
Published: December 2017

Abstract
Multifactorial mechanisms, including varying degrees of polygenic risk, contribute to most child onset psychiatric disorders. Methods to better understand the biological impact of inherited low-risk variation are emerging, and these studies may be useful to develop novel treatments for childhood onset psychiatric disorders. In some neurodevelopmental disorders, specifically autism spectrum disorder (ASD) and intellectual disability (ID), recurrent spontaneously mutated genes have been identified. This leads to the current focus on individual, high-risk targets (e.g., SHANK3, FMR1, MECP2, CHD8) for development of novel treatments. This chapter summarizes and begins to compare neurobiological data from several distinct single gene disorders as a means to guide further therapeutic development based on overlapping pathways of interest.
DSM-5 Overview and Goals
Authors: Regier Darrel A. , Morris Sarah E. , Schultz Susan K. 
Published: December 2017

Abstract
This chapter provides an overview of the developmental history of the DSM-5 and its relationship to the ICD-11 and the NIMH Research Domain Criteria (RDoC) research initiative. The emergence of differences in genetic processes and brain structure and function associated with psychiatric symptoms and disorders, as well as the development of advanced statistical approaches for conducting integrative analyses of biological correlates, phenomenological symptoms, and trait characteristics, has advanced a more complex approach to mental disorder diagnosis and classification. Categorical diagnoses of specific mental disorders are seen in a spectrum context as having porous rather than strict boundaries, with a future goal of diagnostic conceptualizations that incorporate more dimensional measures of pathological symptoms as well as neurobiological mechanisms.
The Present and Future of Psychiatric Diagnosis
Authors: Hyman Steven E. 
Published: December 2017

Abstract
Psychiatric disorders are currently diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders and the closely related International Classification of Diseases. Both diagnostic classification schemes are descriptive and based on a collection of signs and symptoms associated with a given disorder. The fundamental weakness of the schemes is that they are not based on the underlying genetic or neurobiological etiology or pathophysiology of a disorder which of course remain unknown for all common psychiatric syndromes. As more is learned about the biological basis of a mental disorder it will be possibly increasingly to build more accurate diagnostic schemes with greater prognostic and treatment validity.
The Nimh Research Domain Criteria Project
Authors: Cuthbert Bruce N. 
Published: December 2017

Abstract
The Research Domain Criteria (RDoC) project grew from recognized deficiencies in currently used diagnostic schemes for mental illness, such as the Diagnostic and Statistical Manual of Mental Disorders (DSM). While the latter is based on a series of signs and symptoms of illnesses that can co-occur in groups of individuals, without consideration of underlying biological factors, RDoC is based on the increasing ability to relate normal as well as abnormal behavior to particular molecules and circuits in the brain across animal species and humans. Behavioral domains include negative valence systems (e.g., fear and anxiety), positive valence systems (e.g., reward and motivation), cognitive systems, social processes, and arousal and regulatory systems, several of which might be affected in a given DSM disease classification. RDoC is seen as a step toward a “precision psychiatry,” where increasing knowledge of the genetic, molecular, cellular, and circuit basis of mental illness will yield biologically based diagnoses that offer important pathophysiological, treatment, and prognostic implications.
Demography of global ageing
Authors: Bloom David E. , Mitgang Elizabeth , Osher Benjamin 
Published: December 2017

Abstract
Individuals aged 65 years and older currently make up a larger share of the population than ever before, and this group is predicted to continue growing both in absolute terms and relative to the rest of the population. This chapter begins by introducing the facts, figures, and forecasts surrounding the ageing of populations across different countries at varying levels of development. In light of these trends, we examine challenges facing greying societies through the lenses of health, economics, and policy development. The chapter concludes with a selection of adaptable strategies that countries might consider to mitigate the strain—and to harness the full potential—of ageing populations worldwide.
History taking and physical examination
Authors: Ribera-Casado José M. 
Published: December 2017

Abstract
In geriatric medicine, history taking and physical examination differ from the way that these clinical skills are traditionally recommended for younger patients. The definitive approach to a full diagnostic appraisal is through a ‘comprehensive geriatric assessment’. This takes time, and may need modification of the use of language and of the physical setting. Social situation, physical and mental function, and bioethical personal values are essential components of this approach. The findings from a careful, systematic, and detailed physical examination can never be replaced by biological or clinical tests. Physical findings typical for some clinical conditions in younger patients may be absent in older patients and some significant findings are particular to older patients. Certain aspects of assessment tend to be more commonly overlooked, including full medication history including self-medicating habits, nutritional status, and evidence suggesting physical, sexual, or mental abuse.
Principles of medication management
Authors: Le Couteur David G. , McLachlan Andrew J. , Hilmer Sarah N. 
Published: December 2017

Abstract
Older people use numerous medications, yet the evidence for effectiveness in old age is often limited while the evidence for medication-related harm is substantial. Issues common in older people such as multimorbidity, polypharmacy, frailty, dementia, and terminal illnesses influence the decision to prescribe or deprescribe. Age-related changes in drug disposition, coupled with concerns about adverse drug reactions often necessitate lower maintenance doses. Medical ethics and the principles of pharmacokinetics and pharmacodynamics provide overarching frameworks to tailor evidence-based medicine and single disease guidelines to the individual needs and goals of older and frail people. Close monitoring combined with the assumption that any symptom can be medication-related are key clinical skills required for the ongoing optimization of medication use in older people.
Geriatric patients in the emergency department
Authors: Melady Don , Goldlist Barry J. 
Published: December 2017

Abstract
This chapter addresses strategies for closing the ‘quality gap’ between the needs of complex older patients presenting to an emergency department (ED) and what current EDs mostly provide. It reviews historical reasons that the current system often fails to address the multiple and multifactorial needs of an older person in the ED. It explores domains of care—complex and atypical presentations, an awareness of polymorbidity, polypharmacy, falls, cognitive impairment, and end-of-life issues—that are specific to the older ED patient. It suggests opportunities for quality improvement in the essential components of a senior-friendly ED, summarizing some of the changes to staffing, education, policies, procedures, and physical design that prioritize the needs of older patients. It identifies the importance of the ED’s role in the continuum of care and opportunities for improving transitions of care involving the ED.
The emergence of ageing phenotypes and multisystem decline
Authors: Fabbri Elisa , Zoli Marco , Ferrucci Luigi 
Published: December 2017

Abstract
Ageing is characterized by multisystem morphological and physiological changes, which occur very heterogeneously across different individuals. The resulting phenotype is so dynamic and complex that its comprehensive description is still a critical area of research in gerontology. The progressive multisystem instability and deterioration that characterize ageing are, however, very heterogeneous among different individuals. Many researchers believe that such instability is the result of stochastic accumulation of damage and loss of function rather than the consequence of precisely controlled and genetically programmed processes. In approaching such complexity, we have proposed that the phenotypes of ageing can be clustered in discrete interactive domains, whose impairments can serve as proxy measures of the rate of ageing, since they strongly relate to loss of resilience, development of multimorbidity, and occurrence of geriatric syndromes in older adults.
Anorexia of ageing
Authors: Landi Francesco , Martone Anna Maria , Calvani Riccardo , Marzetti Emanuele 
Published: December 2017

Abstract
Anorexia of ageing, defined as the loss of appetite and/or decreased food intake in late life, is a notable paradigm of geriatric syndromes. The latter expression originated because the multifaceted clinical conditions that are common among frail older persons are not easily grouped into specific diseases or ‘traditional’ syndrome categories. Anorexia is indeed highly prevalent and is recognized as an independent predictor of morbidity and mortality in different clinical settings. Even though anorexia is not an unavoidable consequence of ageing, advancing age often promotes its development through various mechanisms. Age-related changes in lifestyle, disease conditions, as well as social and environmental factors have the potential to directly affect dietary behaviours and nutritional status. Anorexia of ageing is indeed associated with many of the syndromes and effects that occur when the accumulation of health impairments in multiple systems combine to make older persons more vulnerable to internal and/or external stressors.
Protein and energy requirements in health and illness
Authors: Bauer Jürgen M. , Diekmann Rebecca 
Published: December 2017

Abstract
The preservation of functionality in elders is closely associated with their nutritional status. In this context it is pivotal for them to meet their nutritional requirements, which vary according to their individual needs. The latter are influenced to a large degree by activity level and comorbidity. Most older individuals will cover their energy needs in the range 25–30 kcal/kg body weight (BW) per day, but in extreme states like hyperkinetic dementia, the daily energy requirement may amount to 40 kcal/kg BW per day. To achieve optimal protein intake, older persons will need more protein per kg BW than the World Health Organization (WHO) recommendation of 0.8 g/kg BW per day, which was not varied according to age. For slowing the associated decline in muscle mass and bone quality, 1.0–1.2 g protein/kg BW per day is recommended. In older individuals with relevant comorbidity, even higher protein intake is advisable.
Metabolic syndrome
Authors: Maggi Stefania , Crepaldi Gaetano 
Published: December 2017

Abstract
Two of the major determinants of rising healthcare costs in Western society are represented by population ageing, which is accompanied by a parallel increase in age-associated diseases and disabilities, as well as by obesity and its related comorbidities. Many studies have shown that selected risk factors such as impaired glucose tolerance, atherogenic dyslipidemia, and hypertension co-occur to a greater degree than that expected by chance alone in obese individuals (especially in those with central obesity). Their co-occurrence has been defined as ‘metabolic syndrome’, a multifactorial disease of substantial heterogeneity, a major risk factor for type 2 diabetes mellitus, atherosclerotic cardiovascular disease (CVD) and, in the older population, also for cancer, cognitive decline, functional dependence, depression, low quality of life, and mortality. Identifying and treating metabolic syndrome (MS) is thus of vital importance because it could lead to a significant decrease in the burden of morbidity and mortality in older patients.
Headaches and facial pain
Authors: Weatherall Mark 
Published: December 2017

Abstract
Headache and facial pain generally become less frequent as people age, but nonetheless remain common problems in the older population, with a one year prevalence of about 50%. Primary headache disorders such as tension-type headache, migraine, or cluster headache may present de novo, or persist into old age; atypical features may become more common, and attacks more difficult to treat. Rarer primary disorders causing headache or facial pain, such as trigeminal neuralgia, short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT syndrome), hypnic headache, and primary cough headache predominantly or exclusively affect older people, but secondary headache and facial pain disorders are likely to account for a greater percentage of diagnoses. Such disorders may be benign, such as cervicogenic headache, or potentially very serious, such as giant cell arteritis or subdural haematoma.
Assessment and management of pain in older people may be challenging.
Seizure disorders and management
Authors: Schachter Steven C. 
Published: December 2017

Abstract
Epilepsy is common and in developed countries with ageing populations, the highest incidence and prevalence of epilepsy is in older people. The classification of seizure types is based on the patient’s or an observer’s description of the seizure. Most new-onset seizures in elderly persons arise from a focal area of the brain, often causing vague and non-specific symptoms or observable behaviours such as motionless staring, blackouts, delirium, disorientation, or limb jerking. The goals of treatment are to fully control seizures without bothersome side effects. Antiepileptic drugs (AEDs) are the mainstay of therapy; selecting an AED is based on a number of factors. Therapy should be initiated with a low dose and slowly titrated as needed. This chapter reviews the epidemiology, clinical evaluation, and treatment considerations for new-onset epilepsy in older people.
Primary and secondary prevention of stroke
Authors: Manning Lisa , Lam Man Yee , Robinson Thompson G. 
Published: December 2017

Abstract
Stroke is one of the leading causes of mortality, morbidity, and disability worldwide. Stroke and transient ischaemic attack survivors are at risk of recurrent stroke, which is often more severe and disabling. Despite the success in acute treatment and rehabilitation of stroke, prevention remains the most effective way to reduce the global burden of the disease. Since preventative strategies have early effectiveness, prompt recognition of symptoms, specialist assessment and diagnosis, and initiation of these secondary prevention strategies are of utmost importance in stroke prevention. This chapter provides an overview of current primary and secondary stroke prevention strategies, highlighting the importance of rapid recognition, urgent specialist care, and evidence-based interventions, which are the cornerstones of effective management.
Neurological rehabilitation
Authors: Kwan Joseph S. K. , Tse Mona M. Y. , Li Leonard S. W. 
Published: December 2017

Abstract
Neurological rehabilitation aims to help people regain functional independence from physical and cognitive disabilities caused by neurological injuries or diseases, improving their participation in the society and quality of life. Among older patients, the more common need for neurological rehabilitation arises from acute stroke, traumatic brain injury, or spinal cord damage. There has been a recent paradigm shift in the approach of neurological rehabilitation towards promoting neural reorganization, restructure and modification of brain activity patterns (neuroplasticity). Stroke patients benefit from organized interdisciplinary care within a comprehensive stroke unit, followed by early supported discharge in the community. Early intensive therapy and prevention of complications such as infections are the key components of acute neurological rehabilitation. In the post-acute period, a problem-oriented approach using evidence-based strategies can enhance neuroplasticity and patient outcome. Special attention is needed for traumatic brain injury and spinal injury, younger patients, and those with neurocognitive dysfunction.
Pharmacological interventions in mild cognitive impairment and dementia
Authors: Hugon Jacques , Paquet Claire 
Published: December 2017

Abstract
Alzheimer’s disease (AD) and other dementias are a major public health concern in many countries because of population ageing. The aetiologic causes of most of the dementias are unknown and recent pharmacological interventions are based on hypotheses such as the ‘amyloid cascade hypothesis’ for AD. Drugs can be divided between symptomatic treatments and disease-modifying drugs. So far regulatory authorities have only approved choline esterase inhibitors (ChEIs) and memantine in AD. It is postulated that the brain lesions in this disease occur 10–15 years before the first clinical signs. New clinical trials are now also including patients with mild cognitive impairment, a stage which often precedes dementia. Primary and secondary outcomes incorporate neuropsychological evaluations but also biomarker assessments such as positon emission tomography (PET) imaging and cerebrospinal fluid (CSF) measurements. This chapter focuses on current available therapies and recent or ongoing clinical trials in mild cognitive impairment and dementias.
A new model of care for patients with dementia: the Japanese initiative for dementia care
Authors: Maki Yohko , Sakurai Takashi , Toba Kenji 
Published: December 2017

Abstract
Facing the unprecedented ageing society, Japan’s contribution to the world should be to lead worldwide discussion on dementia care. This chapter introduces the Japanese initiatives for dementia care. For realization of a society where people with dementia live well, the new concept of ‘prosocial relationship-based care’ for dementia has been introduced as the ethical background; community members are expected to reach out helping hands to each person with dementia to restore their participation in society. Based on this basic concept and the long-term care insurance system, various measures related to primary, secondary and tertiary preventive approaches for dementia have been promoted to achieve appropriate and seamless coordination of medical and long-term care. To establish prosocial relationships, it is critical to promote cooperation among various stakeholders, and develop community networks and social resources.
Older people with substance problems
Authors: Crome Ilana , Rao Rahul (Tony) 
Published: December 2017

Abstract
Not only is the number of older people in our society is increasing, but their use of substances is rising. All substances should be considered (i.e. alcohol, tobacco, polypharmacy, illicit drugs, over-the-counter medication, substances obtained over the internet, and misuse of prescription drugs). Associated mental health and physical health difficulties need to be viewed in light of the combination of substances and interactions with clinical conditions. The service delivery system is unprepared partly due to an invisible epidemic fuelled by numerous factors including ageism, denial, stereotypes, and non-specific symptoms. A thorough ongoing routine assessment of substance use is the keystone of a treatment management plan. Older people willing to be engaged in a multidisciplinary team treatment do have capacity to change, and outcomes are at least was positive as their young adult counterpart. There are gaps about treatment prevalence, the facilitators and barriers to treatment, including comorbid conditions.