bluuebunny/crossref_metadata_2025_split huggingface dataset:
Why has AMBIT come about?
Authors: Talbot Laura , Fuggle Peter 
Published: February 2023

Abstract
This introductory chapter explains the structure and rationale of the book. The Adaptive Mentalization-Based Integrative Treatment (AMBIT) model has been developed to support professionals and networks working to help individuals with multiple needs; the model has undergone significant development in recent years, partly in response to the experiences of implementation and adaptation by different professions in different contexts described in this book. Some of the main issues that shape the AMBIT model are outlined: that many clients have multiple needs, that multiple needs attract multiple helpers, collaboration is hard to achieve, and the vital importance but fragility of the helping process. Attention is drawn to the importance of attachment theory to the model, and the importance of the worker’s state of mind in the helping process. Key features of a non-mentalizing helping system are described: lack of trust, a lack of making sense of behaviour, loss of narrative continuity, not holding the balance between perspectives when designing help, and problems with planning.
Epistemic trust and mistrust in helping systems
Authors: Fonagy Peter , Campbell Chloe 
Published: February 2023

Abstract
Recent developments in the theoretical underpinning of the AMBIT model are described in this chapter. Mentalizing theory is explained, including the concepts of the non-mentalizing modes: pretend mode, teleological mode, and psychic equivalence. Mentalizing is then applied to wider social systems and the importance of a mentalizing system around an individual in sustaining that individual’s capacity to mentalize is explained. The capacity to work cooperatively and collaboratively is understood in terms of the capacity for joint attention and the emergence of co-mentalizing, or the ‘we-mode’. It is through the experience of the we-mode that epistemic trust is generated, which is essential for social communication and learning. The implications of operating in a non-mentalizing system for professionals working in a helping context are described.
Working out what is going on
Authors: Talbot Laura 
Published: February 2023

Abstract
AMBIT Integrative Measure (AIM) cards are used in AMBIT practice to help a client and a worker develop a relationship that is both trusting and purposeful. The AIM cards are a pack of 40 cards, approximately the size of a typical set of playing cards. Each card represents an area of a person’s life and functioning, and the cards cover seven domain categories: daily life, socioeconomic factors, family relationships, social relationships, mental state, response to situation, and measure of complexity. The AIM cards can be used for a variety of purposes, including building a picture of a client’s strengths and needs (i.e. as an assessment tool), building a shared understanding of how a client’s difficulties have developed and connect with each other (i.e. as a formulation tool), supporting goal-setting, and as a way of measuring outcomes via the use of the rating scale. This chapter describes how the AIM cards can be used in various ways to support the client and worker to develop a shared sense of purpose.
Getting started with AMBIT
Authors: Dangerfield Mark 
Published: February 2023

Abstract
This chapter uses the implementation of AMBIT with an outreach community team for adolescents in Barcelona to describe the application of AMBIT principles in a new setting. The application of key AMBIT principles drawn from the AMBIT quadrant—Working with your Client, Working with your Team, Working with your Network, and Learning at Work—are described in reference to a case study involving one adolescent and the wider context in which implementation was taking place. The chapter describes the need to understand the impact of adverse relational experiences on adolescent mental health, and the implications of such experiences on a young person’s capacity for epistemic trust.
Enhancing multiprofessional cooperation in a child and youth social service institution
Authors: Huter Beate , Hollenstein Michael 
Published: February 2023

Abstract
This chapter describes the implementation of AMBIT in a combined residential, educational, and outreach service for children and adolescents in Austria. Particular aspects of AMBIT practice are explained as salient to the needs of the service, in particular, providing a mentalizing environment for professionals at risk of emotional burnout and dealing with increasing case complexity within the service. The four quadrants of the AMBIT wheel—Working with your Client, Working with your Team, Working with your Network, and Learning at Work—are covered, drawing on examples from clinical practice. The evaluation process for the service is described, explaining how evaluation was implemented and the key findings of the evaluation.
Creating and supporting a Team around the Worker
Authors: Talbot Laura 
Published: February 2023

Abstract
The Team around the Worker is one of the central, unique concepts in the AMBIT approach. This chapter uses a case example from the Adolescent Multi-Agency Support Service in London, a service that was set up and designed around the principle of the Team around the Worker—in this case, the social worker working with a family in which the removal of a child into care is being considered. The chapter describes how effective multiagency helping systems require a close level of attention to detail about the process of beginning helping relationships, attention to the beliefs and attitudes of both clients and workers, and recognition of the vulnerabilities that clients and workers may experience in this process.
Working with networks
Authors: Vilmar Janne Walløe , Jensen Stefan Lock 
Published: February 2023

Abstract
This chapter describes the implementation of the AMBIT approach within the healthcare system in Denmark. Using a case study involving complex needs and high risk in which network dis-integration was a real danger, the chapter explains how the application and adaptation of AMBIT principles was used in order to support the keyworker. An integration between the AMBIT approach and milieu therapy is discussed, via an emphasis shared by both models on the importance of mentalizing systems. The NET-Aim-Questionnaire was developed by this team to improve the functioning of network meetings and combat network dis-integration.
Chronic Low Back and Leg Pain
Authors: Attal Nadine , Bouhassira Didier 
Published: February 2023

Abstract
This chapter presents the case of a 48-year-old woman who was operated from L4–L5 left discal herniation and spinal stenosis. Despite surgery, she continues to suffer from chronic low back and neuropathic leg pain. Lumbar magnetic resonance imaging does not show any new pathological image of discal herniation. She has received acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and epidural corticosteroid infiltrations without any efficacy; does not tolerate weak opioids; and is afraid of moving. Physical reconditioning and psychological advice are recommended. Opioids should not be proposed as first line, and conventional analgesics and NSAIDs are generally ineffective; lumbar epidural steroid injections are controversial. For chronic neuropathic (radicular) pain, recommendations should follow general guidelines for peripheral neuropathic pain.
Groin Pain After Hernia Repair
Authors: Attal Nadine , Bouhassira Didier 
Published: February 2023

Abstract
This chapter presents the case of a 32-year-old man who suffers from persisting neuropathic groin pain after surgery for left inguinal hernia (open surgery). Examination of the painful area discloses mild sensory deficit, allodynia to brush as well as red skin and swelling. Because he did not want to receive oral medications, he was treated by topical agents. Postsurgical pain is commonly neuropathic, with common causes being hernia repair but also thoracotomy, mastectomy, knee/hip replacement, cholecystectomy, and varicose vein stripping. Management is similar to that of other peripheral neuropathic pains, but topical treatments should be preferred if the area of pain is small.
Pain and Paresthesia of the Hand
Authors: Trouvin Anne-Priscille 
Published: February 2023

Abstract
This chapter presents the case of a 42-year-old woman with rheumatoid arthritis (RA) who describes tingling, pins and needles and sometimes burning pain at the right wrist and palmar area of the thumb and index, extending to the forearm. Clinical examination shows no sensorimotor deficit, and percussion of the median nerve at the wrist induces paresthesia. Carpal tunnel syndrome is frequent in RA and mainly a clinical diagnosis. Complementary explorations are not always mandatory. Nerve conduction studies may provide objective confirmation of decreased sensory and motor conduction of the median nerve at the wrist. Imaging particularly using ultrasound can help when there is strong suspicion of a local cause of compression. Nonsurgical treatment includes rest, splinting, and local corticosteroid injections. In refractory cases or when there is motor involvement, surgical decompression is indicated.
Pain After Surgery for Hand Fracture
Authors: Sendel Manon , Gierthmühlen Janne , Baron Ralf 
Published: February 2023

Abstract
This chapter discusses the case of a patient who presents with persistent pain after a radial fracture and additionally experiences swelling, changes of skin color, and impaired range of motion. When differential diagnoses are excluded, a diagnosis of neuropathic pain or complex regional pain syndrome (CRPS) is possible. CRPS is diagnosed clinically according to the Budapest criteria, which include symptoms reported by the patient as well as signs that can be objectified in the clinical exam. Sometimes, additional methods, such as quantitative sensory testing and three-phase bone scintigraphy (3PBS), can be helpful. Because of the lack of sufficient data, CRPS therapy is mostly based on guidelines for neuropathic pain. It should always be interdisciplinary and multimodal.
Cold-Evoked Symptoms After Chemotherapy
Authors: Ventzel Lise , Finnerup Nanna Brix 
Published: February 2023

Abstract
This chapter presents the case of a man who has cold dysesthesia due to oxaliplatin-induced peripheral neuropathy. Chemotherapy-induced peripheral neuropathy is a daily challenge in cancer patients. Oxaliplatin can cause an acute neuropathy characterized by cold dysesthesia, a chronic neuropathy characterized by a “glove-and-stocking-like” distribution of symptoms (paresthesia, dysesthesia, and pain), and sensory loss. There are no established preventive treatments. In patients with oxaliplatin-induced neuropathy, treatment mainly consists of symptomatic antineuropathic drugs akin to other painful neuropathies, and it should not start with opioids. Patients with chemotherapy-induced neuropathy reporting paresthesia such as numbness or tingling but not pain should not be treated with analgesics.
My Body Is Boiling
Authors: Attal Nadine , Bouhassira Didier , Truini Andrea 
Published: February 2023

Abstract
This chapter presents the case of a woman who initially developed pain involving the lower limbs, compatible with sensory neuropathy (specifically small fiber neuropathy), and now reports pain “all over the body,” associated with multiple other symptoms, fulfilling criteria for fibromyalgia. Fibromyalgia may classically develop in the context of rheumatological diseases, such as chronic arthritis or spondylosis, but also in relation with stress, sleep disorders, past traumatic events, or any focal painful injury. Fibromyalgia may also be associated with painful (small fiber) neuropathy, but it is unclear whether the neuropathy is a trigger or may cause the pain and associated symptoms in fibromyalgia syndrome. Therapeutic management should be based on the clinical phenotype and include mainly therapeutic education, physical reconditioning, and cognitive–behavior therapy.
Burning Mouth
Authors: Attal Nadine , Bouhassira Didier 
Published: February 2023

Abstract
This chapter presents the case of an elderly woman who suffers from chronic bilateral pain in the tongue described as burning. Pain is moderately improved by chewing gum but is worse in the evening or after talking. Examination of the tongue is normal, and there is no apparent sensory deficit. Biological testing is normal. This case is compatible with primary burning mouth syndrome (BMS). Although BMS is not considered as neuropathic, it has many similarities with neuropathic pains in terms of symptoms and mechanisms. Guidelines for neuropathic pain may apply to BMS with emphasis on pregabalin, gabapentin, and duloxetine. Secondary causes include mainly candidosis. Treatment is difficult, with weak evidence for efficacy of topical clonazepam.
Neuropathic Pain in a Child
Authors: Attal Nadine , Bouhassira Didier 
Published: February 2023

Abstract
This chapter presents the case of an 11-year-old girl with hip osteosarcoma invading the lumbar plexus who suffers from extreme neuropathic pain with tactile allodynia, which is not relieved by strong opioids. This case illustrates that neuropathic pain in children is often related to cancer. Osteosarcoma is the leading type of cancer in children. It may be responsible for neuropathic pain because of plexus lesion, or it may induce nociceptive pain due to bone lesion. Other causes of neuropathic pain in children and adolescents include complex regional pain syndrome, cancer, Guillain–Barré syndrome, spinal cord injury, nerve trauma, and genetic conditions. Treatment of neuropathic pain in children is mainly based on gabapentin.
Topical Therapy
Authors: Attal Nadine , Bouhassira Didier 
Published: February 2023

Abstract
This chapter presents the case of an elderly woman with intercostal postherpetic neuralgia with a well circumscribed and limited area of pain for whom topical agents are probably the best choice. These include U.S. Food and Drug Administration-approved daily use of 5% lidocaine plasters and capsaicin high-concentration patches every 3 months in specialized settings. Subcutaneous botulinum toxin A (off-label) may also be proposed by specialist use if pain is refractory. Topical agents are expected to have less efficacy if the pain is present in an area of total sensory loss. This case report illustrates that it is possible to combine several topical agents due to their distinct mechanisms and their different modalities of applications.
Physical Therapy
Authors: Attal Nadine , Tosti Grégory , Bouhassira Didier 
Published: February 2023

Abstract
This chapter presents the case of a woman with severe complex regional pain syndrome CRPS for whom physiotherapy should be implemented as part of multimodal management. It may be beneficial for motor deficit or neglect, major sensory deafferentation, physical deconditioning, and fear of pain and movement. Because physical exercises may be initially very painful, strong analgesics may be proposed before each exercise to facilitate rehabilitation. Physiotherapy includes a large variety of interventions, particularly manual therapy, therapeutic exercises including physical reconditioning, electrotherapy (e.g., transcutaneous electrical nerve stimulation), and sensorimotor rehabilitation strategies including mirror therapy and graded motor imagery. Virtual reality is increasingly investigated for the treatment of acute pain, but there are limited data regarding its efficacy on neuropathic pain.
Psychotherapies: How, When, and Why
Authors: Attal Nadine , Bouhassira Didier 
Published: February 2023

Abstract
This chapter presents the case of a woman with postsurgical neuropathic pain who is suffering considerably because of multiple life events, social isolation, and anxiety. Psychological therapy plays a major role in the management of chronic neuropathic pain. It aims to decrease dysfunctional coping strategies, thoughts about pain, and catastrophizing, which are common consequences of chronic pain, and improve anxiety and mood. Cognitive–behavioral therapy has been the most studied. Psychotherapies may be recommended as stand-alone or add on to other treatments. Best candidates should be motivated and educated subjects, with maladaptive thoughts about their neuropathic pain and/or mood or anxiety disorders.
Complementary Investigations
Authors: Truini Andrea , Galosi Eleonora 
Published: February 2023

Abstract
This chapter presents the case of a woman with burning pain of the lower legs and lightheadedness when standing up from a sitting position who had normal neurological examination and electromyography. Hence, she was told that pain was “in her head,” but a psychiatrist stated that she did not suffer from a psychiatric condition. She was ultimately diagnosed with small fiber neuropathy based on complementary investigations, including laser evoked potentials and skin punch biopsy. This case illustrates the importance of an in-depth assessment of patients with chronic pain and shows the place of complementary investigations. The fact that pain was limited to the lower limbs and described as neuropathic should orient toward a neurological lesion.
When Do I Refer for Invasive Therapies?
Authors: Attal Nadine , Bouhassira Didier 
Published: February 2023

Abstract
This chapter presents the case of a man who suffers from severe neuropathic pain due to cauda equina syndrome refractory to well-conducted treatments without psychiatric comorbidity. For this patient, invasive therapy may be considered. These techniques should only be considered after multidisciplinary evaluation including psychological assessment. Best candidates are patients with regional neuropathic pain. The choice of treatment depends on the clinical context, the origin of pain, and the area of pain. By far the most documented invasive therapy for neuropathic noncancer pain is spinal cord stimulation. Other invasive techniques include peripheral nerve stimulation or pulsed radiofrequency (minimally invasive), deep brain/epidural motor cortex stimulation, intrathecal therapy, and ablation surgery techniques in select conditions.
Invasive Brain Stimulation and Intrathecal Therapy
Authors: Attal Nadine , Bouhassira Didier 
Published: February 2023

Abstract
This chapter presents the case of a patient with traumatic spinal cord injury responsible for at-level allodynia and below-level spontaneous pain who is totally refractory to first-, second-, and third-line treatments, including noninvasive brain neurostimulation. He is a good candidate for invasive treatments, after multidisciplinary assessment. Because spinal cord stimulation is difficult due to his spinal cord lesion, invasive therapeutic options include intrathecal analgesic therapy or central invasive neurostimulation. Drugs officially labeled by the U.S. Food and Drug Administration for intrathecal administration include morphine, ziconotide, and baclofen. Trialing and small initial dosages are recommended. Motor cortex stimulation involves the placement of electrodes along the surface of the brain in the precentral gyrus, corresponding to the motor cortex area. The level of evidence regarding the efficacy of deep brain stimulation remains inconclusive in neuropathic pain.
Green Vomit . . . Ewwww!!!
Authors: Ro Esther , Jadcherla Yamini , Reynolds Maegan S. 
Published: February 2023

Abstract
The triad of bilious emesis, abdominal pain, and distention in a neonate is suggestive of intestinal obstruction typically from malrotation or midgut volvulus (MGV). Neonates may not always present with all of these findings, and neonates with more subtle findings may rapidly deteriorate and require prompt intervention. Initial resuscitation includes gastric decompression via nasogastric tube and intravenous fluids. Radiographic findings for MGV are nonspecific and can vary from normal to diffuse bowel dilatation. The clinician should not be reassured by normal radiographic imaging in this clinical setting. Fluoroscopic upper gastrointestinal (UGI) series is typically the first-line imaging exam to diagnose or exclude MGV. Ultrasound (US) can demonstrate reversed SMA/SMV relationship, which can indicate malrotation and prompt further evaluation with UGI. Volvulus can be diagnosed on UGI, as well as US. Definitive management includes surgical repair with detorsion of the bowel and a Ladd’s procedure.
My Baby Won’t Poop!
Authors: Jadcherla Yamini , Shet Narendra , Reynolds Maegan S. 
Published: February 2023

Abstract
Constipation is a very common emergency room complaint and is often multifactorial. Clinicians should have a high index of suspicion for Hirschsprung’s disease in infants who fail to pass meconium within the first 24 hours after delivery or who have a history of infrequent explosive bowel movements and poor weight gain. Examination can reveal abdominal distention, tight anal sphincter, and empty rectum with expulsion of gas and stool (positive “squirt sign”). Abdominal radiographs and contrast enemas can help to diagnose a distal obstruction or transition zone but may also be normal. Rectal biopsy is the gold standard for diagnosis. It is important to be mindful of complications of Hirschsprung’s disease, such as colonic perforation and enterocolitis, as these can occur years after surgical repair and have high rates of mortality.
Drooling, Drooling, Drooling All the Way Home
Authors: Lampl Brooke , Orajiaka Nkeiruka , Eby Meika 
Published: February 2023

Abstract
Foreign body (FB) ingestion is a common complaint in patients 6 months to 5 years old. Acute foreign body ingestions can present in many ways, from completely asymptomatic to drooling, difficulty swallowing, choking, respiratory distress, vomiting, and food refusal. Chronic foreign bodies may present with fever, hematemesis, hematochezia, chronic cough, or weight loss. There may be a patient reported history or caregiver-witnessed ingestion; for others, you may need to rely on symptoms and clinical suspicion. The most commonly ingested objects in children are coins, toys, jewelry, and batteries. Button batteries, magnets, and sharp objects require special attention as they are associated with increased morbidity.
Burn, Baby, Burn
Authors: Gotowka Cory , Coblentz Ailish , Stoner Michael 
Published: February 2023

Abstract
Button battery ingestions (BBIs) are the second most frequently ingested foreign bodies, second to coins. Unfortunately, the incidence of BBI continues to rise, with the majority occurring in children younger than 6 years of age. In addition to the increase in incidence, the rate of significant complications and death resulting from BBI has increased nearly sevenfold with the majority of serious outcomes and fatalities occurring in children between 1 and 3 years of age. Button batteries have characteristic radiographic appearances that can facilitate an early diagnosis. Honey may be used as a temporary measure, if it is suspected that the ingestion was less than 12 hours prior (10 mL of oral honey, or 10 mL of oral sucralfate (if the patient is younger than 1 year)). Endoscopy, by a subspecialist, is indicated as soon as possible for removal of the battery.
To Wheeze or Not to Wheeze
Authors: Vachon Linda , Rose Emily 
Published: February 2023

Abstract
Bronchiolitis is a common clinical syndrome of viral etiology in children &lt;2 years of age. Many different viruses cause the presentation of initial upper respiratory symptoms (runny nose) with progression to lower respiratory tract involvement with increased work of breathing and diffuse wheezing and rales present on auscultation. Bronchiolitis is a clinical diagnosis and neither imaging nor laboratory testing is routinely indicated. Atypical presentations may warrant further investigation with a chest radiograph, but the information obtained on imaging rarely changes management in most children with bronchiolitis. Typical findings of viral infection on a chest x-ray are diffuse and include hyperinflation, peribronchial cuffing, and/or segmental or subsegmental atelectasis.