WorldWideScience

Sample records for specific medical disorders

  1. Specific Components of Pediatricians' Medication-Related Care Predict Attention-Deficit/Hyperactivity Disorder Symptom Improvement.

    Science.gov (United States)

    Epstein, Jeffery N; Kelleher, Kelly J; Baum, Rebecca; Brinkman, William B; Peugh, James; Gardner, William; Lichtenstein, Phil; Langberg, Joshua M

    2017-06-01

    The development of attention-deficit/hyperactivity disorder (ADHD) care quality measurements is a prerequisite to improving the quality of community-based pediatric care of children with ADHD. Unfortunately, the evidence base for existing ADHD care quality metrics is poor. The objective of this study was to identify which components of ADHD care best predict patient outcomes. Parents of 372 medication-naïve children in grades 1 to 5 presenting to their community-based pediatrician (N = 195) for an ADHD-related concern and who were subsequently prescribed ADHD medication were identified. Parents completed the Vanderbilt ADHD Parent Rating Scale (VAPRS) at the time ADHD was raised as a concern and then approximately 12 months after starting ADHD medication. Each patient's chart was reviewed to measure 12 different components of ADHD care. Across all children, the mean decrease in VAPRS total symptom score during the first year of treatment was 11.6 (standard deviation 10.1). Of the 12 components of ADHD care, shorter times to first contact and more teacher ratings collected in the first year of treatment significantly predicted greater decreases in patient total symptom scores. Notably, it was timeliness of contacts, defined as office visits, phone calls, or email communication, that predicted more ADHD symptom decreases. Office visits alone, in terms of number or timeliness, did not predict patient outcomes. The magnitude of ADHD symptom decrease that can be achieved with the use of ADHD medications was associated with specific components of ADHD care. Future development and modifications of ADHD quality care metrics should include these ADHD care components. Copyright © 2017 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

  2. Medical comorbidity of sleep disorders.

    Science.gov (United States)

    Dikeos, Dimitris; Georgantopoulos, Georgios

    2011-07-01

    Recently published literature indicates that sleep disorders present with medical comorbidities quite frequently. The coexistence of a sleep disorder with a medical disorder has a substantial impact for both the patient and the health system. Insomnia and hypersomnia are highly comorbid with medical conditions, such as chronic pain and diabetes, as well as with various cardiovascular, respiratory, gastrointestinal, urinary and neurological disorders. Restless legs syndrome and periodic leg movement syndrome have been associated with iron deficiency, kidney disease, diabetes, and neurological, autoimmune, cardiovascular and respiratory disorders. Rapid eye movement behaviour disorder has been described as an early manifestation of serious central nervous system diseases; thus, close neurological monitoring of patients referring with this complaint is indicated. Identification and management of any sleep disorder in medical patients is important for optimizing the course and prognosis. Of equal importance is the search for undetected medical disorder in patients presenting with sleep disorders.

  3. Resistance and mutations of non-specificity in the field of anxiety-depressive disorders in Canadian medical journals, 1950-1990.

    Science.gov (United States)

    Collin, Johanne; Otero, Marcelo

    2015-04-01

    Pharmaceuticalisation is a complex phenomenon, co-constitutive of what scholars identify as a pharmaceutical regime, comprised of networks of actors, institutions and artefacts as well as cognitive structures that underlie the production, promotion and use of medications. The aim of this paper is to explore the linkages between different components of this pharmaceutical regime through the analysis of psychotropic drug advertising in Canadian medical journals between 1950 and 1990. Advertisements stand at the nexus of macro-level processes related to the development, regulation and marketing of new drug treatments and of micro-level processes related to the use of these drug treatments, both by clinicians and lay persons. We thus examine advertisements from the angle of the mental and classificatory universes to which doctors were exposed through direct-to-prescriber advertisement strategies implemented during this period. Furthermore, we explore to what extent the rationale behind advertisements was permeated by both scientific/professional and popular narratives of mind-body connections. This paper demonstrates that, although this period was marked by paradigm shifts in the classification of mental diseases, the development of modern psychopharmacology, and the questioning of the scientific legitimacy of psychiatry, advertisements unveil a remarkable continuity: that of the mass management of anxiety-depressive disorders by primary care physicians through psychotropic drugs. Also, despite the effective resistance to specificity as shown by the constant redefinitions of diagnostic categories and therapeutic indications, our analysis suggests that the language of specificity used in the promotion of new drugs and in the various narratives of mind-body connection may have been appealing to general practitioners. Finally, our study of the classes of psychoactive medications that have been in use for over half a century reveals a complex, non-linear dynamic of

  4. Gender specific issues in hereditary ocular disorders.

    Science.gov (United States)

    Iragavarapu, Saradha; Gorin, Michael B

    2015-02-01

    This review is intended to summarize the current knowledge from basic science and clinical medical literature cited within PubMed that pertain to gender-related factors and affect those individuals with hereditary ocular disorders. We consider gender-related biological factors that (a) affect disease onset and progression, (b) gender differences for major X-linked ocular disorders, (c) gender-specific conditions, (d) medications that may influence genetic eye disorders, and finally, (e) gender-related issues that influence the management and quality of life of these patients. Several studies have demonstrated the manner in which sex-related hormones in animal models are capable of influencing cell pathway and survival that are likely to affect hereditary eye disorders. There are very few clinical studies that provide compelling evidence for gender differences in human ocular conditions, other than for a number of X-linked disorders. Disease expression for X-linked disorders may be impacted by genetic mechanisms such as lyonization or uniparental disomy. Clinical evidence regarding the impact of gender-related medical conditions and therapies on eye conditions is extremely limited and primarily based on anecdotal evidence. Gender-specific factors may play a major role in the underlying biological pathways that influence the onset, rate of progression, and clinical findings associated with ocular genetic conditions. Clinicians need to be aware of the variable phenotypes observed in female carriers of X-linked disorders of gender specific issues, many of which are inadequately addressed in the current literature. Clinicians need to be sensitive to gender differences in social, cultural, and religious systems and they should also be aware of how their own gender biases may influence how they counsel patients. Finally, it is clear that the lack of effective clinical studies in this area creates an opportunity for future research that will have real benefits for these

  5. Conduct disorders as a result of specific learning disorders

    OpenAIRE

    VOKROJOVÁ, Nela

    2012-01-01

    This thesis focuses on relationship between specific learning disorders and conduct disorders in puberty. The theoretical part explains the basic terms apearing in the thesis such as specific learning disorders, conduct disorders, puberty and prevention of conduct disorder formation. It presents Czech and foreign research which have already been done in this and related areas. The empirical part uses a quantitative method to measure anxiety and occurrence of conduct disorders in second grade ...

  6. Prevalence and Polysomnographic Correlates of Insomnia Comorbid with Medical Disorders

    Science.gov (United States)

    Budhiraja, Rohit; Roth, Thomas; Hudgel, David W.; Budhiraja, Pooja; Drake, Christopher L.

    2011-01-01

    Study Objectives: To determine the prevalence and polysomnographic correlates of insomnia in subjects with self-reported medical disorders. Design: Prospective cross-sectional study. Participants: Community-based sample of 3282 men and women aged 18 to 65 years old, with a subset who underwent polysomnography. Measurements: Self-reported measures of sleep habits and current health, and polysomnographic sleep variables. Results: The prevalence of insomnia was 21.4%. The adjusted odds of insomnia were 2.2 times as high in persons with any medical disorders as in those without medical disorders. Specifically, odds of insomnia were higher in people with heart disease (OR = 1.6 [95% CI: 1.2-23], P = 0.004), hypertension (1.5 [12-18], P insomnia increased with increasing number of medical disorders. However, polysomnographic sleep was not significantly different in persons with or without medical disorders for most disorders assessed. Conclusion: This large population-based study suggests that insomnia is highly prevalent in diverse chronic medical disorders. However, polysomnographic evidence of disturbed sleep is present in only a subset of comorbid insomnia populations. Citation: Budhiraja R; Roth T; Hudgel DW; Budhiraja P; Drake CL. Prevalence and polysomnographic correlates of insomnia comorbid with medical disorders. SLEEP 2011;34(7):859-867. PMID:21731135

  7. The medical management of attention-deficit / hyperactivity disorder ...

    African Journals Online (AJOL)

    This paper focuses specifically on the medical management of attention-deficit / hyperactivity disorder (ADHD) and the options currently available in South Africa. References are made to current thinking on the etiology of this disorder and the pharmacological principles involved in its treatment. This review will not try to ...

  8. Comorbid medical illness in bipolar disorder.

    Science.gov (United States)

    Forty, Liz; Ulanova, Anna; Jones, Lisa; Jones, Ian; Gordon-Smith, Katherine; Fraser, Christine; Farmer, Anne; McGuffin, Peter; Lewis, Cathryn M; Hosang, Georgina M; Rivera, Margarita; Craddock, Nick

    2014-12-01

    Individuals with a mental health disorder appear to be at increased risk of medical illness. To examine rates of medical illnesses in patients with bipolar disorder (n = 1720) and to examine the clinical course of the bipolar illness according to lifetime medical illness burden. Participants recruited within the UK were asked about the lifetime occurrence of 20 medical illnesses, interviewed using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and diagnosed according to DSM-IV criteria. We found significantly increased rates of several medical illnesses in our bipolar sample. A high medical illness burden was associated with a history of anxiety disorder, rapid cycling mood episodes, suicide attempts and mood episodes with a typically acute onset. Bipolar disorder is associated with high rates of medical illness. This comorbidity needs to be taken into account by services in order to improve outcomes for patients with bipolar disorder and also in research investigating the aetiology of affective disorder where shared biological pathways may play a role. Royal College of Psychiatrists.

  9. Medication Treatment for Attention Deficit Hyperactivity Disorder

    Science.gov (United States)

    Ryan, Joseph B.; Katsiyannis, Antonis; Hughes, Elizabeth M.

    2011-01-01

    Attention deficit hyperactivity disorder (ADHD) has become the most commonly diagnosed psychiatric disorder among school-age children. For more than half a century, physicians have prescribed medications to help manage behaviors such as hyperactivity, impulsivity, and inattention. Today, there is a growing consensus that ADHD is a biologically…

  10. Medical Comorbidities in Attention Deficit Hyperactivity Disorder

    Directory of Open Access Journals (Sweden)

    Irem Yalug

    2009-09-01

    Full Text Available Attention Deficit Hyperactivity Disorder is one of the most common developmental disorders of childhood with a reported world-wide prevalence of 8 to 12 %. In studies conducted in our country the prevalence rates in community were reported to vary between 8.6 to 8.1 % while clinical prevalence rates were reported to vary between 8.6 to 29.44 %. Fifty to eighty percent of cases were reported to continue into adolescence while thirty to fifty percent may continue into adulthood. Attention deficit hyperactivity disorder is known to accompany subtle physical anomalies, allergic and neurologic disorders, obesity and eating disorders, traumatic injuries, risky sexual behavior, sleep disorders, substance and alcohol use, axis I and II disorders, occupational, legal and academic problems and increased treatment expenditures. Though the effects of this disorder continue throughout life, create burdens to the society along with its treatment as well as disabling the affected patients through their lives, and receive increasing attention in recent years, reviews focusing on problems associated with it are lacking. Therefore, this study aimed to summarize the results of previous studies conducted about medical comorbidities in attention deficit hyperactivity disorder.

  11. Medical makeup: the correction of hyperpigmentation disorders.

    Science.gov (United States)

    Nonni, J

    2012-12-01

    Medical makeup corrects skin tone imperfections with dermocosmetic products, which bring together tolerance efficacy, colour neutralization and sun protection. Highly suitable for imperfections caused by hyperpigmentation, it allows patients affected by these disorders to cover them up effectively and discretely, giving them a better quality of life. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  12. [Medical makeup: the correction of hyperpigmentation disorders].

    Science.gov (United States)

    Nonni, J

    2012-11-01

    Medical makeup corrects skin tone imperfections with dermo-cosmetic products, which bring together tolerance efficacy, colour neutralization and sun protection. Highly suitable for imperfections caused by hyperpigmentation, it allows patients affected by these disorders to cover them up effectively and discretely, giving them a better quality of life. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  13. Autobiographical memory specificity in dissociative identity disorder.

    Science.gov (United States)

    Huntjens, Rafaële J C; Wessel, Ineke; Hermans, Dirk; van Minnen, Agnes

    2014-05-01

    A lack of adequate access to autobiographical knowledge has been related to psychopathology. More specifically, patients suffering from depression or a history of trauma have been found to be characterized by overgeneral memory, in other words, they show a relative difficulty in retrieving a specific event from memory located in time and place. Previous studies of overgeneral memory have not included patients with dissociative disorders. These patients are interesting to consider, as they are hypothesized to have the ability to selectively compartmentalize information linked to negative emotions. This study examined avoidance and overgeneral memory in patients with dissociative identity disorder (DID; n = 12). The patients completed the autobiographical memory test (AMT). Their performance was compared with control groups of posttraumatic stress disorder (PTSD) patients (n = 26), healthy controls (n = 29), and DID simulators (n = 26). Specifically, we compared the performance of separate identity states in DID hypothesized to diverge in the use of avoidance as a coping strategy to deal with negative affect. No significant differences in memory specificity were found between the separate identities in DID. Irrespective of identity state, DID patients were characterized by a lack of memory specificity, which was similar to the lack of memory specificity found in PTSD patients. The converging results for DID and PTSD patients add empirical evidence for the role of overgeneral memory involved in the maintenance of posttraumatic psychopathology.

  14. Sleep disorder among medical students: relationship to their academic performance.

    Science.gov (United States)

    Abdulghani, Hamza M; Alrowais, Norah A; Bin-Saad, Norah S; Al-Subaie, Nourah M; Haji, Alhan M A; Alhaqwi, Ali I

    2012-01-01

    Medical students are exposed to a significant level of pressure due to academic demands. Their sleep pattern is characterized by insufficient sleep duration, delayed sleep onset, and occurrence of napping episodes during the day. To examine the prevalence of sleep disorder among medical students and investigate any relationship between sleep disorder and academic performance. This is a cross-sectional self-administered questionnaire-based study. The participants were medical students of the first, second, and third academic years. The Epworth Sleepiness Scale (ESS) was also included to identify sleep disorder and grade point average was recorded for academic performance. There were 491 responses with a response rate of 55%. The ESS score demonstrated that 36.6% of participants were considered to have abnormal sleep habits, with a statistically significant increase in female students (p = 0.000). Sleeping between 6-10 h per day was associated with normal ESS scores (p = 0.019) as well as the academic grades ≥ 3.75. Abnormal ESS scores were associated with lower academic achievement (p = 0.002). A high prevalence of sleep disorder was found in this group of students, specifically female students. Analysis of the relationship between sleep disorder and academic performance indicates a significant relationship between abnormal ESS scores, total sleeping hours, and academic performance.

  15. Cognitive Clusters in Specific Learning Disorder.

    Science.gov (United States)

    Poletti, Michele; Carretta, Elisa; Bonvicini, Laura; Giorgi-Rossi, Paolo

    The heterogeneity among children with learning disabilities still represents a barrier and a challenge in their conceptualization. Although a dimensional approach has been gaining support, the categorical approach is still the most adopted, as in the recent fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. The introduction of the single overarching diagnostic category of specific learning disorder (SLD) could underemphasize interindividual clinical differences regarding intracategory cognitive functioning and learning proficiency, according to current models of multiple cognitive deficits at the basis of neurodevelopmental disorders. The characterization of specific cognitive profiles associated with an already manifest SLD could help identify possible early cognitive markers of SLD risk and distinct trajectories of atypical cognitive development leading to SLD. In this perspective, we applied a cluster analysis to identify groups of children with a Diagnostic and Statistical Manual-based diagnosis of SLD with similar cognitive profiles and to describe the association between clusters and SLD subtypes. A sample of 205 children with a diagnosis of SLD were enrolled. Cluster analyses (agglomerative hierarchical and nonhierarchical iterative clustering technique) were used successively on 10 core subtests of the Wechsler Intelligence Scale for Children-Fourth Edition. The 4-cluster solution was adopted, and external validation found differences in terms of SLD subtype frequencies and learning proficiency among clusters. Clinical implications of these findings are discussed, tracing directions for further studies.

  16. 78 FR 18837 - Revised Medical Criteria for Evaluating Visual Disorders

    Science.gov (United States)

    2013-03-28

    ... updating our regulations is to address advances in medical technology and terminology. We have removed the... Medical Criteria for Evaluating Visual Disorders AGENCY: Social Security Administration. ACTION: Final..., Office of Medical Listings Improvement, Social Security Administration, 6401 Security Boulevard...

  17. Screening and Evaluation of Medications for Treating Cannabis Use Disorder

    Science.gov (United States)

    Panlilio, Leigh V.; Justinova, Zuzana; Trigo, Jose M.; Le Foll, Bernard

    2016-01-01

    Cannabis use has been increasingly accepted legally and in public opinion. However, cannabis has the potential to produce adverse physical and mental health effects and can result in cannabis use disorder (CUD) in a substantial percentage of both occasional and daily cannabis users. Many people have difficulty discontinuing use. Therefore, it would be beneficial to develop safe and effective medications for treating CUD. To achieve this, methods have been developed for screening and evaluating potential medications using animal models and controlled experimental protocols in human volunteers. In this chapter we describe: 1) animal models available for assessing the effect of potential medications on specific aspects of CUD; 2) the main findings obtained so far with these animal models; 3) the approaches used to assess potential medications in humans in laboratory experiments and clinical trials; and 4) the effectiveness of several potential pharmacotherapies on the particular aspects of CUD modeled in these human studies. PMID:27055612

  18. Evaluating and treating anxiety disorders in medical settings.

    OpenAIRE

    Ball S; Goddard A; Shekhar A

    2002-01-01

    Anxiety disorders and medical illness present to the primary care physician as a common comorbidity. This article aims to review the literature on the prevalence of anxiety disorders in patients presenting to primary care physicians; to address the key issues in assessing the comorbid condition; and to discuss psychological and pharmacological treatment options for patients with a comorbid anxiety disorder and medical illness. Anxiety disorders are highly prevalent within the primary care pop...

  19. Evaluating and treating anxiety disorders in medical settings.

    Directory of Open Access Journals (Sweden)

    Ball S

    2002-10-01

    Full Text Available Anxiety disorders and medical illness present to the primary care physician as a common comorbidity. This article aims to review the literature on the prevalence of anxiety disorders in patients presenting to primary care physicians; to address the key issues in assessing the comorbid condition; and to discuss psychological and pharmacological treatment options for patients with a comorbid anxiety disorder and medical illness. Anxiety disorders are highly prevalent within the primary care population, and these disorders significantly impact the patient′s course and outcome. Fortunately, primary care physicians have a variety of effective cognitive, behavioral and pharmacological interventions available for managing these patients with comorbid anxiety and medical illnesses.

  20. Specific learning disorder: prevalence and gender differences.

    Directory of Open Access Journals (Sweden)

    Kristina Moll

    Full Text Available Comprehensive models of learning disorders have to consider both isolated learning disorders that affect one learning domain only, as well as comorbidity between learning disorders. However, empirical evidence on comorbidity rates including all three learning disorders as defined by DSM-5 (deficits in reading, writing, and mathematics is scarce. The current study assessed prevalence rates and gender ratios for isolated as well as comorbid learning disorders in a representative sample of 1633 German speaking children in 3rd and 4th Grade. Prevalence rates were analysed for isolated as well as combined learning disorders and for different deficit criteria, including a criterion for normal performance. Comorbid learning disorders occurred as frequently as isolated learning disorders, even when stricter cutoff criteria were applied. The relative proportion of isolated and combined disorders did not change when including a criterion for normal performance. Reading and spelling deficits differed with respect to their association with arithmetic problems: Deficits in arithmetic co-occurred more often with deficits in spelling than with deficits in reading. In addition, comorbidity rates for arithmetic and reading decreased when applying stricter deficit criteria, but stayed high for arithmetic and spelling irrespective of the chosen deficit criterion. These findings suggest that the processes underlying the relationship between arithmetic and reading might differ from those underlying the relationship between arithmetic and spelling. With respect to gender ratios, more boys than girls showed spelling deficits, while more girls were impaired in arithmetic. No gender differences were observed for isolated reading problems and for the combination of all three learning disorders. Implications of these findings for assessment and intervention of learning disorders are discussed.

  1. Evaluation of changes in prescription medication use after a residential treatment programme for borderline personality disorder.

    Science.gov (United States)

    Broadbear, Jillian H; Nesci, Julian; Thomas, Rosemary; Thompson, Katherine; Beatson, Josephine; Rao, Sathya

    2016-12-01

    Residential patients diagnosed with borderline personality disorder were evaluated to determine whether borderline personality disorder-focused psychotherapy reduced prescribing, personality disorder and co-morbid symptom severity. Psychotropic prescriptions were measured at admission, discharge and 1 year later in 74 female participants with one or more personality disorder diagnosis and co-morbid mood disorders. Changes in pharmacotherapy were examined in the context of improvements in borderline personality disorder and/or co-morbid disorder symptom severity. Residential treatment included individual and group psychotherapy for borderline personality disorder. The Structured Clinical Interview for DSM-IV was used to confirm the borderline personality disorder diagnosis and associated co-morbid conditions. The Beck Depression Inventory was completed at each time point. A significant reduction in the incidence and severity of self-rated depression as well as clinician assessed personality disorder, including borderline personality disorder, was accompanied by a reduction in prescription of psychoactive medications. Three to six months of intensive borderline personality disorder-specific psychotherapy showed lasting benefit with regard to symptom severity of personality disorders (borderline personality disorder in particular) as well as depressive symptoms. This improvement corresponded with a reduction in prescriptions for psychoactive medications, which is consistent with current thinking regarding treatment for borderline personality disorder. © The Royal Australian and New Zealand College of Psychiatrists 2016.

  2. 75 FR 71632 - Revised Medical Criteria for Evaluating Mental Disorders

    Science.gov (United States)

    2010-11-24

    ... Revised Medical Criteria for Evaluating Mental Disorders AGENCY: Social Security Administration. ACTION... comments on any other aspects of the proposed listings for mental disorders that we receive during this... our mental disorders listings: Definitions we provide for the terms ``marked'' and ``extreme'' that...

  3. New Developments in Insomnia Medications of Relevance to Mental Health Disorders.

    Science.gov (United States)

    Krystal, Andrew D

    2015-12-01

    Many insomnia medications with high specificity have become available recently. They provide a window into the clinical effects of modulating specific brain systems and establish a new guiding principal for conceptualizing insomnia medications: "mechanism matters." A new paradigm for insomnia therapy in which specific drugs are selected to target the specific type of sleep difficulty for each patient includes administering specific treatments for patients with insomnia comorbid with particular psychiatric disorders. This article reviews insomnia medications and discusses the implications for optimizing the treatment of insomnia occurring comorbid with psychiatric conditions. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Medical Devices Assess, Treat Balance Disorders

    Science.gov (United States)

    2009-01-01

    You may have heard the phrase as difficult as walking and chewing gum as a joking way of referring to something that is not difficult at all. Just walking, however, is not all that simple physiologically speaking. Even standing upright is an undertaking requiring the complex cooperation of multiple motor and sensory systems including vision, the inner ear, somatosensation (sensation from the skin), and proprioception (the sense of the body s parts in relation to each other). The compromised performance of any of these elements can lead to a balance disorder, which in some form affects nearly half of Americans at least once in their lifetimes, from the elderly, to those with neurological or vestibular (inner ear) dysfunction, to athletes with musculoskeletal injuries, to astronauts returning from space. Readjusting to Earth s gravity has a significant impact on an astronaut s ability to balance, a result of the brain switching to a different "model" for interpreting sensory input in normal gravity versus weightlessness. While acclimating, astronauts can experience headaches, motion sickness, and problems with perception. To help ease the transition and study the effects of weightlessness on the body, NASA has conducted many investigations into post-flight balance control, realizing this research can help treat patients with balance disorders on Earth as well. In the 1960s, the NASA-sponsored Man Vehicle Laboratory at the Massachusetts Institute of Technology (MIT) studied the effects of prolonged space flight on astronauts. The lab s work intrigued MIT doctoral candidate Lewis Nashner, who began conducting NASA-funded research on human movement and balance under the supervision of Dr. Larry Young in the MIT Department of Aeronautics and Astronautics. In 1982, Nashner s work resulted in a noninvasive clinical technique for assessing the cooperative systems that allow the body to balance, commonly referred to as computerized dynamic posturography (CDP). CDP employs a

  5. An introduction to Kundalini yoga meditation techniques that are specific for the treatment of psychiatric disorders.

    Science.gov (United States)

    Shannahoff-Khalsa, David S

    2004-02-01

    The ancient system of Kundalini yoga includes a vast array of meditation techniques and many were discovered to be specific for treating the psychiatric disorders as we know them today. One such technique was found to be specific for treating obsessive-compulsive disorder (OCD), the fourth most common psychiatric disorder, and the tenth most disabling disorder worldwide. Two published clinical trials are described here for treating OCD using a specific Kundalini yoga protocol. This OCD protocol also includes techniques that are useful for a wide range of anxiety disorders, as well as a technique specific for learning to manage fear, one for tranquilizing an angry mind, one for meeting mental challenges, and one for turning negative thoughts into positive thoughts. Part of that protocol is included here and published in detail elsewhere. In addition, a number of other disorder-specific meditation techniques are included here to help bring these tools to the attention of the medical and scientific community. These techniques are specific for phobias, addictive and substance abuse disorders, major depressive disorders, dyslexia, grief, insomnia and other sleep disorders.

  6. Cognitive Clusters in Specific Learning Disorder

    Science.gov (United States)

    Poletti, Michele; Carretta, Elisa; Bonvicini, Laura; Giorgi-Rossi, Paolo

    2018-01-01

    The heterogeneity among children with learning disabilities still represents a barrier and a challenge in their conceptualization. Although a dimensional approach has been gaining support, the categorical approach is still the most adopted, as in the recent fifth edition of the "Diagnostic and Statistical Manual of Mental Disorders." The…

  7. Medical Considerations in Children and Adolescents with Eating Disorders.

    Science.gov (United States)

    DerMarderosian, Diane; Chapman, Heather A; Tortolani, Christina; Willis, Matthew D

    2018-01-01

    Eating disorders are a group of psychiatric disorders with potentially fatal medical complications. Early integrated care including the family as well as pediatric medicine, nutrition, psychology and psychiatry is critical for improving prognosis and limiting negative outcomes. Mental health services are a critical component of treatment; timely weight restoration maximizes efficacy. Despite being relatively common, there are many misperceptions about eating disorders, their severity, and the associated morbidity and mortality. Opportunities exist within the medical and psychiatric communities for a better understanding of the complexity of diagnosing and treating patients with eating disorders. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Childhood maltreatment and the medical morbidity in bipolar disorder: a case-control study.

    Science.gov (United States)

    Hosang, Georgina M; Fisher, Helen L; Uher, Rudolf; Cohen-Woods, Sarah; Maughan, Barbara; McGuffin, Peter; Farmer, Anne E

    2017-09-07

    Childhood maltreatment (abuse and neglect) can have long-term deleterious consequences, including increased risk for medical and psychiatric illnesses, such as bipolar disorder in adulthood. Emerging evidence suggests that a history of childhood maltreatment is linked to the comorbidity between medical illnesses and mood disorders. However, existing studies on bipolar disorder have not yet explored the specific influence of child neglect and have not included comparisons with individuals without mood disorders (controls). This study aimed to extend the existing literature by examining the differential influence of child abuse and child neglect on medical morbidity in a sample of bipolar cases and controls. The study included 72 participants with bipolar disorder and 354 psychiatrically healthy controls (average age of both groups was 48 years), who completed the Childhood Trauma Questionnaire, and were interviewed regarding various medical disorders. A history of any type of childhood maltreatment was significantly associated with a diagnosis of any medical illness (adjusted OR = 6.28, 95% confidence intervals 1.70-23.12, p = 0.006) and an increased number of medical illnesses (adjusted OR = 3.77, 95% confidence intervals 1.34-10.57, p = 0.012) among adults with bipolar disorder. Exposure to child abuse was more strongly associated with medical disorders than child neglect. No association between childhood maltreatment and medical morbidity was detected among controls. To summarise, individuals with bipolar disorder who reported experiencing maltreatment during childhood, especially abuse, were at increased risk of suffering from medical illnesses and warrant greater clinical attention.

  9. Performance specifications for proton medical facility

    Energy Technology Data Exchange (ETDEWEB)

    Chu, W.T.; Staples, J.W.; Ludewigt, B.A.; Renner, T.R.; Singh, R.P.; Nyman, M.A.; Collier, J.M.; Daftari, I.K.; Petti, P.L.; Alonso, J.R. [Lawrence Berkeley Lab., CA (United States); Kubo, H.; Verhey, L.J. [University of California Davis Medical Center, Sacramento, CA (United States). Cancer Center]|[California Univ., San Francisco, CA (United States). School of Medicine; Castro, J.R. [Lawrence Berkeley Lab., CA (United States)]|[University of California Davis Medical Center, Sacramento, CA (United States). Cancer Center]|[California Univ., San Francisco, CA (United States). School of Medicine

    1993-03-01

    Performance specifications of technical components of a modern proton radiotherapy facility are presented. The technical items specified include: the accelerator; the beam transport system including rotating gantry; the treatment beamline systems including beam scattering, beam scanning, and dosimetric instrumentation; and an integrated treatment and accelerator control system. Also included are treatment ancillary facilities such as diagnostic tools, patient positioning and alignment devices, and treatment planning systems. The facility specified will accommodate beam scanning enabling the three-dimensional conformal therapy deliver .

  10. Prevalence of Medical Disorders in Pregnancy in Ebonyi State ...

    African Journals Online (AJOL)

    Background: Pregnancy is a physiological state, but when associated with an underlying medical disorder, it has a large ..... bacteriuria in pregnant women versus inpatient treatment ... implication of routine screen for asymptomatic bacteria.

  11. Comorbidity and medication in REM sleep behavior disorder

    DEFF Research Database (Denmark)

    Frauscher, Birgit; Jennum, Poul; Ju, Yo-El S

    2014-01-01

    OBJECTIVE: This controlled study investigated associations between comorbidity and medication in patients with polysomnographically confirmed idiopathic REM sleep behavior disorder (iRBD), using a large multicenter clinic-based cohort. METHODS: Data of a self-administered questionnaire...

  12. Critical gaps in the medical knowledge base of eating disorders.

    Science.gov (United States)

    Gibson, Dennis; Drabkin, Anne; Krantz, Mori J; Mascolo, Margherita; Rosen, Elissa; Sachs, Katherine; Welles, Christine; Mehler, Philip S

    2018-04-21

    Eating disorders are unique in that they inherently have much medical comorbidity both as a part of restricting-type eating disorders and those characterized by purging behaviors. Over the last three decades, remarkable progress has been made in the understanding and treatment of the medical complications of eating disorders. Yet, unfortunately, there is much research that is sorely needed to bridge the gap between current medical knowledge and more effective and evidence-based medical treatment knowledge. These gaps exist in many different clinical areas including cardiology, electrolytes, gastrointestinal and bone disease. In this paper, we discuss some of the knowledge gap areas, which if bridged would help develop more effective medical intervention for this population of patients.

  13. Disorder-specific neuroanatomical correlates of attentional bias in obsessive-compulsive disorder, panic disorder, and hypochondriasis

    NARCIS (Netherlands)

    van den Heuvel, O.A.; Veltman, D.J.; Groenewegen, H.J.; Witter, M.P.; Merkelbach, J.; Cath, D.C.; van Balkom, A.J.; van Oppen, P.; van Dyck, R.

    2005-01-01

    Context: Attentional bias to disease-relevant emotional cues is considered to be pathogenetically relevant in anxiety disorders. Objective: To investigate functional neural correlates and disease specificity of attentional bias across different anxiety disorders. Design: A cognitive and emotional

  14. Disorder-specific neuroanatomical correlates of attentional bias in obsessive-compulsive disorder, panic disorder, and hypochondriasis

    NARCIS (Netherlands)

    van den Heuvel, Odile A.; Veltman, Dick J.; Groenewegen, Henk J.; Witter, Menno P.; Merkelbach, Jille; Cath, Danielle C.; van Balkom, Anton J. L. M.; van Oppen, Patricia; van Dyck, Richard

    2005-01-01

    CONTEXT: Attentional bias to disease-relevant emotional cues is considered to be pathogenetically relevant in anxiety disorders. OBJECTIVE: To investigate functional neural correlates and disease specificity of attentional bias across different anxiety disorders. DESIGN: A cognitive and emotional

  15. Autobiographical Memory Specificity in Dissociative Identity Disorder

    NARCIS (Netherlands)

    Huntjens, R.J.C.; Wessel, I.; Hermans, D.; Minnen, A. van

    2014-01-01

    A lack of adequate access to autobiographical knowledge has been related to psychopathology. More specifically, patients suffering from depression or a history of trauma have been found to be characterized by overgeneral memory, in other words, they show a relative difficulty in retrieving a

  16. Autobiographical memory specificity in dissociative identity disorder

    NARCIS (Netherlands)

    Huntjens, Rafaële J. C.; Wessel, Ineke; Hermans, Dirk; van Minnen, Agnes

    A lack of adequate access to autobiographical knowledge has been related to psychopathology. More specifically, patients suffering from depression or a history of trauma have been found to be characterized by overgeneral memory, in other words, they show a relative difficulty in retrieving a

  17. Psychiatric disorders and general medical conditions: implications ...

    African Journals Online (AJOL)

    African Journal of Psychiatry ... They are also at increased risk of contracting HIV. ... As medical practice becomes more specialized and arguably compartmentalized it may increasingly fail to integrate health care for patients with severe mental ...

  18. Polygenic risk for five psychiatric disorders and cross-disorder and disorder-specific neural connectivity in two independent populations.

    Science.gov (United States)

    Wang, Tianqi; Zhang, Xiaolong; Li, Ang; Zhu, Meifang; Liu, Shu; Qin, Wen; Li, Jin; Yu, Chunshui; Jiang, Tianzi; Liu, Bing

    2017-01-01

    Major psychiatric disorders, including attention deficit hyperactivity disorder (ADHD), autism (AUT), bipolar disorder (BD), major depressive disorder (MDD), and schizophrenia (SZ), are highly heritable and polygenic. Evidence suggests that these five disorders have both shared and distinct genetic risks and neural connectivity abnormalities. To measure aggregate genetic risks, the polygenic risk score (PGRS) was computed. Two independent general populations (N = 360 and N = 323) were separately examined to investigate whether the cross-disorder PGRS and PGRS for a specific disorder were associated with individual variability in functional connectivity. Consistent altered functional connectivity was found with the bilateral insula: for the left supplementary motor area and the left superior temporal gyrus with the cross-disorder PGRS, for the left insula and right middle and superior temporal lobe associated with the PGRS for autism, for the bilateral midbrain, posterior cingulate, cuneus, and precuneus associated with the PGRS for BD, and for the left angular gyrus and the left dorsolateral prefrontal cortex associated with the PGRS for schizophrenia. No significant functional connectivity was found associated with the PGRS for ADHD and MDD. Our findings indicated that genetic effects on the cross-disorder and disorder-specific neural connectivity of common genetic risk loci are detectable in the general population. Our findings also indicated that polygenic risk contributes to the main neurobiological phenotypes of psychiatric disorders and that identifying cross-disorder and specific functional connectivity related to polygenic risks may elucidate the neural pathways for these disorders.

  19. Medical Marijuana in Certain Neurological Disorders

    Science.gov (United States)

    ... is also known as cannabis. Medical marijuana is cannabis used as medicine. When used as a drug, marijuana can produce ... THC). CBD and THC are taken from the cannabis plant for use in medicine. They also can be created (synthesized) in a ...

  20. Social communication deficits: Specific associations with Social Anxiety Disorder.

    Science.gov (United States)

    Halls, Georgia; Cooper, Peter J; Creswell, Cathy

    2015-02-01

    Social communication deficits are prevalent amongst children with anxiety disorders; however whether they are over-represented specifically among children with Social Anxiety Disorder has not been examined. This study set out to examine social communication deficits among children with Social Anxiety Disorder in comparison to children with other forms of anxiety disorder. Parents of 404 children with a diagnosed anxiety disorder completed the Social Communication Questionnaire (SCQ; Rutter, M., Bailey, A., Lord, C., 2003. The Social Communication Questionnaire - Manual. Western Psychological Services, Los Angeles, CA). Children with a diagnosis of Social Anxiety Disorder (n=262) and anxious children without Social Anxiety Disorder (n=142) were compared on SCQ total and subscale scores and the frequency of participants scoring above clinical cut-offs. Children with Social Anxiety Disorder scored significantly higher than anxious children without Social Anxiety Disorder on the SCQ total (t(352)=4.85, p<.001, d=.55, r=.27), Reciprocal Social Interaction (t(351)=4.73, p<.001, d=.55, r=.27), communication (t(344)=3.62, p<.001, d=.43, r=.21) and repetitive, restrictive and stereotyped behaviors subscales (t(353)=3.15, p=.002, d=.37, r=.18). Furthermore, children with Social Anxiety Disorder were three times more likely to score above clinical cut-offs. The participants were a relatively affluent group of predominantly non-minority status. The social communication difficulties measure relied on parental report which could be influenced by extraneous factors. Treatments for Social Anxiety Disorder may benefit from a specific focus on developing social communication skills. Future research using objective assessments of underlying social communication skills is required. Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.

  1. Trends in Opioid Use Disorder Diagnoses and Medication Treatment Among Veterans With Posttraumatic Stress Disorder.

    Science.gov (United States)

    Shiner, Brian; Leonard Westgate, Christine; Bernardy, Nancy C; Schnurr, Paula P; Watts, Bradley V

    2017-01-01

    Despite long-standing interest in posttraumatic stress disorder (PTSD) and opioid use disorder comorbidity, there is a paucity of data on the prevalence of opioid use disorder in patients with PTSD. Therefore, there is limited understanding of the use of medications for opioid use disorder in this population. We determined the prevalence of diagnosed opioid use disorder and use of medications for opioid use disorder in a large cohort of patients with PTSD. We obtained administrative and pharmacy data for veterans who initiated PTSD treatment in the Department of Veterans Affairs (VA) between 2004 and 2013 (N = 731,520). We identified those with a comorbid opioid use disorder diagnosis (2.7%; n = 19,998) and determined whether they received a medication for opioid use disorder in the year following their initial clinical PTSD diagnosis (29.6%; n = 5,913). Using logistic regression, we determined the predictors of receipt of opioid use disorder medications. Comorbid opioid use disorder diagnoses increased from 2.5% in 2004 to 3.4% in 2013. Patients with comorbid opioid use disorder used more health services and had more comorbidities than other patients with PTSD. Among patients with PTSD and comorbid opioid use disorder, use of medications for opioid use disorder increased from 22.6% to 35.1% during the same time period. Growth in the use of buprenorphine (2.0% to 22.7%) was accompanied by relative decline in use of methadone (19.3% to 12.7%). Patients who received buprenorphine were younger and more likely to be rural, White, and married. Patients who received methadone were older, urban, unmarried, from racial and ethnic minorities, and more likely to see substance abuse specialists. While use of naltrexone increased (2.8% to 8.6%), most (87%) patients who received naltrexone also had an alcohol use disorder. Controlling for patient factors, there was a substantial increase in the use of buprenorphine, a substantial decrease in the use of methadone, and no change

  2. Eating disorder emergencies: understanding the medical complexities of the hospitalized eating disordered patient.

    Science.gov (United States)

    Cartwright, Martina M

    2004-12-01

    Eating disorders are maladaptive eating behaviors that typically develop in adolescence and early adulthood. Psychiatric maladies and comorbid conditions, especially insulin-dependent diabetes mellitus, frequently co-exist with eating disorders. Serious medical complications affecting all organs and tissues can develop and result in numerous emergent hospitalizations. This article reviews the pathophysiologies of anorexia nervosa, bulimia nervosa, and orthorexia nervosa and discusses the complexities associated with the treatment of medical complications seen in these patients.

  3. Job-specific mandatory medical examinations for the police force

    NARCIS (Netherlands)

    Boschman, J. S.; Hulshof, C. T. J.; Frings-Dresen, M. H. W.; Sluiter, J. K.

    2017-01-01

    Background Mandatory medical examinations (MMEs) of workers should be based on the health and safety requirements that are needed for effectively performing the relevant work. For police personnel in the Netherlands, no job-specific MME exists that takes the specific tasks and duties into account.

  4. Dyssomnias, parasomnias, and sleep disorders associated with medical and psychiatric diseases.

    Science.gov (United States)

    Barthlen, G M; Stacy, C

    1994-03-01

    Sleep disorders can be intrinsic, as are insomnia or narcolepsy, or can be accounted for by external factors, such as noise, altitude, drug or alcohol abuse, or shift work. The arousal disorders, common in children, are usually benign and disappear by puberty. Sleep-wake transition disorders such as sleep starts are benign as well, and may occur at any age. The parasomnias comprise different entities such as nightmares, REM-sleep behavior disorder, sleep enuresis, and bruxism. Diagnosis and treatment often require a multidisciplinary approach. Virtually every psychiatric, neurologic, or medical disease, when of sufficient severity, leaves its specific fingerprint on sleep; some disorders, such as peptic ulcer disease, gastroesophageal reflux, or epilepsy, tend to be exacerbated during sleep. Fortunately, most sleep disorders are amenable to therapy, which can include counseling, sleep hygiene, withholding of an offending agent, behavioral therapy, light therapy, or cautious drug therapy.

  5. Sport specificity of mental disorders: the issue of sport psychiatry.

    Science.gov (United States)

    Bär, Karl-Jürgen; Markser, Valentin Z

    2013-11-01

    The prevalence of psychiatric conditions among elite athletes is still under debate. More and more evidence has accumulated that high-performance athletes are not protected from mental disorders as previously thought. The authors discuss the issue of the sport specificity of selected mental diseases in elite athletes. Specific aspects of eating disorders, exercise addiction, chronic traumatic encephalopathy and mood disorders in the context of overtraining syndrome are examined. In particular, the interrelationship between life and work characteristics unique to elite athletes and the development of mental disorders are reviewed. Differences of clinical presentation and some therapeutic consequences are discussed. The authors suggest that the physical and mental strains endured by elite athletes might influence the onset and severity of their psychiatric disorder. Beside the existing research strategies dealing with the amount of exercise, its intensity and lack of recreation experienced by athletes, further research on psycho-social factors is needed to better understand the sport-specific aetiology of mental disorders in high-performance athletes.

  6. Non medical factors associated with psychological disorders in cancer patients

    International Nuclear Information System (INIS)

    Iqbal, A.; Intikhab, K.; Saeed, K.

    2002-01-01

    Objective: To find out major non-medial factors associated with psychological disorders in cancer patients. Design: An observational study conducted on adult cancer patients. Place and Duration of Study: The study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Center Lahore Pakistan from January 1999. Patients and Methods: Two hundred and twenty-four newly-diagnosed adult cancer patients were interviewed by the clinical psychologist and data was collected regarding non-medical causal factors, patients age, gender family support system, general home atmosphere and marital status. Collected data was analyzed by utilizing. SPSS for windows version 10.0. Results: Of the 224 patients 142 (63.4%) reported non-medical factors causing psychological distress and 82 (36.6%) reported that medical sources are the most distressing. Ten most common non-medical sources of developing psychological disorders were identified. It was observed that family support system and general home atmosphere were significantly associated with the development of psychological disorders whereas the other variables such as age, gender and marital status had no significant relationship with the non Medical factors. Conclusion: It was concluded that non-medical factors causing psychological problems are significant in cancer patients. The results suggest that we should identify these factors and target psychosocial intervention for those patients most at risk. (author)

  7. Specifics of mental disorders of patients with metabolic syndrome

    Directory of Open Access Journals (Sweden)

    K. I. Kleban

    2017-09-01

    Full Text Available In the general-somatic network there is a steady increase in the number of patients with psychosomatic disorders. Problems of providing adequate psychiatric and psychotherapeutic assistance to this category of patients are related to the motivation of patients to participate in psychological measures and the readiness of the medical system to provide comprehensive care on the basis of the biopsychosocial approach. Mental factors are involved both in the occurrence and course of a metabolic syndrome in the form of a patient's lifestyle and behavior patterns of healthy functioning, and is a consequence of somatic pathology. Mental factors are involved both in the occurrence and course of a metabolic syndrome in the form of a patient's lifestyle and behavior patterns of healthy functioning, and is a consequence of somatic pathology. So mental disorders of metabolic syndrome are manifested in the form of psychosocial maladaptation, neurotic, affective, personality, and organic disorders. Desynchronosis which is a factor of the development of a metabolic syndrome and characterizes the complex chronobiological component of the regulation of psychophysiological functions in norm and under the influence of stress, deserves special attention. Addressing the diagnosis of mental disorders associated with metabolic syndrome is precisely aimed at determining chronobiological disorders of psychosomatic integrated areas and is supposed to improve diagnostic and treatment process and to shorten the treatment of these disorders.

  8. 78 FR 25521 - Revised Medical Criteria for Evaluating Visual Disorders

    Science.gov (United States)

    2013-05-01

    ... SOCIAL SECURITY ADMINISTRATION [Docket No. SSA-2010-0078] Revised Medical Criteria for Evaluating Visual Disorders AGENCY: Social Security Administration. ACTION: Final rules; Correction. SUMMARY: The Social Security Administration published a document in the Federal Register of March 28, 2013, in FR Doc...

  9. Premenstrual dysphoric disorder among medical students of a ...

    African Journals Online (AJOL)

    Abstract. Background/Objective: This study aimed at estimating the prevalence and associated factors of premenstrual dysphoric disorder (PMDD) among medical students in a University in the ... symptoms and is associated with impairment of social and role functioning. .... includes depressed mood, anxiety, mood lability,.

  10. Prevalence of Alcohol use Disorders among Medical and Surgical in ...

    African Journals Online (AJOL)

    reasons include inadequate medical school and residency training in addictions and a lack of adequate faculty role models who intervene and diagnose alcohol dependence (30). The likelihood that a physician will detect and address alcohol use disorders in patients varies according to the physician's field of training (8).

  11. Common mental disorders among medical students in Jimma ...

    African Journals Online (AJOL)

    2017-09-03

    Sep 3, 2017 ... Department of Psychiatry, College of Health Science, Jimma University, Ethiopia. 2. Laska Meles ... Cite as: Kerebih H, Ajaeb M, Hailesilassie H. Common mental disorders among medical students in Jimma University, SouthWest Ethiopia. Afri ..... Edméa FC, Margleice MR, Ana Teresa RS, Enaldo VM,.

  12. The relation between burnout and sleep disorders in medical students.

    Science.gov (United States)

    Pagnin, Daniel; de Queiroz, Valéria; Carvalho, Yeska Talita Maia Santos; Dutra, Augusto Sergio Soares; Amaral, Monique Bastos; Queiroz, Thiago Thomasin

    2014-08-01

    The aim of this study is to assess the mutual relationships between burnout and sleep disorders in students in the preclinical phase of medical school. This study collected data on 127 medical students who filled in the Maslach Burnout Inventory-Student Survey, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Beck Depression Inventory, and Beck Anxiety Inventory. Hierarchical logistic regressions tested the reciprocal influence between sleep disorders and burnout, controlling for depression and anxiety. Regular occurrence of emotional exhaustion, poor sleep quality, and excessive daytime sleepiness affected 60, 65, and 63% of medical students, respectively. Emotional exhaustion and daytime sleepiness influenced each other. Daytime sleep dysfunctions affected unidirectionally the occurrence of cynicism and academic efficacy. The odds of emotional exhaustion (odds ratio (OR)=1.21, 95% confidence interval (CI)=1.08 to 1.35) and cynicism (OR=2.47, 95% CI=1.25 to 4.90) increased when daytime sleepiness increased. Reciprocally, the odds of excessive daytime sleepiness (OR=2.13, 95% CI=1.22 to 3.73) increased when emotional exhaustion worsened. Finally, the odds of academic efficacy decreased (OR=0.86, 95% CI=0.75 to 0.98) when daytime sleepiness increased. Burnout and sleep disorders have relevant bidirectional effects in medical students in the early phase of medical school. Emotional exhaustion and daytime sleepiness showed an important mutual influence. Daytime sleepiness linked unidirectionally with cynicism and academic efficacy.

  13. [Social cognition disorders in Klinefelter syndrome: A specific phenotype? (KS)].

    Science.gov (United States)

    Babinet, M-N; Rigard, C; Peyroux, É; Dragomir, A-R; Plotton, I; Lejeune, H; Demily, C

    2017-10-01

    The Klinefelter syndrome (KS) is a genetic condition characterized by an X supernumerary sex chromosome in males. The syndrome is frequently associated with cognitive impairment. Indeed, the different areas of the executive sphere can be affected such as inhibition, cognitive flexibility but also attentional and visual-spatial domain. Social cognition disorders, predominantly on emotional recognition processes, have also been documented. In addition, the syndrome may be associated with psychiatric symptoms. Our study aims to characterize of the various components of social cognition in the SK: facial emotional recognition, theory of mind and attributional style. For this two groups (SK group versus control group) of participants (n=16) matched for age and sociocultural level were recruited. Participants with intellectual disabilities, psychiatric or neurological disorders were excluded. Three social cognition tests were available: the TREF, the MASC, the AIHQ. Neurocognitive functions were assessed by the fNart, the subtest "logical memory" of the MEM-III, the subtests of the two VOSP battery, the d2, the TMT and the Stroop test. The SK group had specific social cognition disorders in comparison to the control group. Two emotions in particular were less well recognized: fear and contempt. In addition, the SK group had significantly lower results in theory of mind. Regarding the hostile attribution bias, no significant difference was found. Finally, the results showed correlations between specific attentional disorders and facial emotional recognition. Our study emphasizes social cognition disorders in SK. These disorders could be considered as a phenotypic trait in the syndrome. The interest of better characterizing the cognitive phenotype of genetic disorders that can affect the neurodevelopment is to offer specific cognitive remediation strategies. Copyright © 2016. Published by Elsevier Masson SAS.

  14. Specific Syndromes and Associated Communication Disorders: A Review.

    Science.gov (United States)

    Sanger, Dixie D.; And Others

    1984-01-01

    The review, intended to provide speech-language pathologists and special educators with an awareness of genetics and specific syndromes involving speech, language, and hearing components, discusses basic etiologies of abnormal development and selected syndromes (such as Down's and Klinefelter's) that include communication disorders. (CL)

  15. Working Memory Deficits in Children with Specific Learning Disorders

    Science.gov (United States)

    Schuchardt, Kirsten; Maehler, Claudia; Hasselhorn, Marcus

    2008-01-01

    This article examines working memory functioning in children with specific developmental disorders of scholastic skills as defined by ICD-10. Ninety-seven second to fourth graders with a minimum IQ of 80 are compared using a 2 x 2 factorial (dyscalculia vs. no dyscalculia; dyslexia vs. no dyslexia) design. An extensive test battery assesses the…

  16. Statistical text classifier to detect specific type of medical incidents.

    Science.gov (United States)

    Wong, Zoie Shui-Yee; Akiyama, Masanori

    2013-01-01

    WHO Patient Safety has put focus to increase the coherence and expressiveness of patient safety classification with the foundation of International Classification for Patient Safety (ICPS). Text classification and statistical approaches has showed to be successful to identifysafety problems in the Aviation industryusing incident text information. It has been challenging to comprehend the taxonomy of medical incidents in a structured manner. Independent reporting mechanisms for patient safety incidents have been established in the UK, Canada, Australia, Japan, Hong Kong etc. This research demonstrates the potential to construct statistical text classifiers to detect specific type of medical incidents using incident text data. An illustrative example for classifying look-alike sound-alike (LASA) medication incidents using structured text from 227 advisories related to medication errors from Global Patient Safety Alerts (GPSA) is shown in this poster presentation. The classifier was built using logistic regression model. ROC curve and the AUC value indicated that this is a satisfactory good model.

  17. Medication refusal in children with oppositional defiant disorder or conduct disorder and comorbid attention-deficit/hyperactivity disorder: medication history and clinical correlates.

    Science.gov (United States)

    Demidovich, Mark; Kolko, David J; Bukstein, Oscar G; Hart, Jonathan

    2011-02-01

    Abstract Objective: This study examines the characteristics of 96 children with attention-deficit/hyperactivity disorder (ADHD) and their families who refused a recommendation for medication as part of their treatment for disruptive disorders. The ADHD cases were taken from a sample of 139 youth (age 6-11) who were recruited for a clinical trial that compared the administration of a modular psychosocial treatment in an outpatient clinic or community settings. Medication management was an optional treatment module for children with ADHD in both conditions. Children who were (vs. were not) taking medication at intake, and children who accepted (vs. refused) medication recommendations during the study were compared on diagnostic and clinical measures related to child, school, parent, and family domains of functioning. Parents of 30% of the children refused study medication for ADHD. Parental medication acceptability and intake correlated highly with both medication history and study refusal of medication. Increased parental self-efficacy and emotional support for their youth correlated with medication refusal. No demographics and few child or school factors were associated with medication refusal. Medication use was associated with reductions in some key ADHD symptoms, but did not affect disruptive behaviors as did the psychosocial interventions. Medication refusers remain poorly understood but certain correlates, such as parental self-efficacy, parental emotional support for their youth, and medication acceptability, warrant further evaluation.

  18. [Correlation between specific and nonspecific posttraumatic stress disorder symptoms with healthcare consumption among 340 French soldiers].

    Science.gov (United States)

    Holterbach, L; Baumann, C; Andreani, B; Desré, D; Auxéméry, Y

    2015-10-01

    The psychotraumatic disorders are often difficult to diagnose because the specific symptoms of posttraumatic stress disorder (revival, hyperarousal, avoidance) are rarely a direct demand for health care: for reasons determined by the psychopathological structure of trauma, its symptomatology and course, the psychotraumatised subjects seek a care system for nonspecific psychological or somatoform symptoms: depressive episode, cognitive disorders, other anxiety disorders, histrionic and obsessive symptoms, changes in personality, pain disorders and somatization. Somatic pain may also result from a war injury and psychosomatic complications, addictive or consequences of risk behaviours during the evolution of posttraumatic stress disorder. To establish a correlation between the PCLS and the evaluation of the healthcare consumption in a military population. We conducted a multicenter epidemiological study analyzing the PCLS and a questionnaire assessing health care consumption. The PCLS has been studied in various forms: quantitative (17 to 85), in qualitative classes (disorders, could be developed a score of health care consumption which would include the number of days of sick leave and unavailability, the number and quality of medical consultations, the number and quality of drug and laboratory requirements, the number of hospitalisations. To the identification of posttraumatic stress disorder, the PCLS score as well as the consumer healthcare score are valuable tools but do not replace the subjectivity of the clinical relationship: return to this shared subjectivity with the practitioner remains a diagnostic dimension, but also therapeutic, fundamental. Copyright © 2015 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

  19. Multiple Antipsychotic Medication Use in Autism Spectrum Disorder.

    Science.gov (United States)

    Wink, Logan K; Pedapati, Ernest V; Horn, Paul S; McDougle, Christopher J; Erickson, Craig A

    2017-02-01

    The purpose of this study was to explore the use of multiple antipsychotic medications in patients with autism spectrum disorder (ASD) by reviewing the longitudinal medication management of 1100 patients consecutively treated for behavioral symptoms associated with ASD at a tertiary care specialty clinic. We identified all patients with ASD treated with daily doses of two or more antipsychotics for at least two visits at our clinic. For each patient meeting inclusion criteria, diagnostic and demographic data were collected. To evaluate clinical need and effectiveness of antipsychotic medications in this sample, we reviewed symptoms targeted with each antipsychotic medication and concomitant medications prescribed. Clinical Global Impressions-Severity (CGI-S) and Clinical Global Impressions-Improvement (CGI-I) scale ratings had been completed at the time of each visit, and the duration of treatment with antipsychotic medications was determined. To evaluate the safety and tolerability of antipsychotic medication use in ASD, we reviewed reported adverse effects and calculated body mass index (BMI) change with treatment. Seventy patients met the inclusion criteria (6.4% of our sample). The majority of patients were moderately to severely ill Caucasian males, as determined by baseline mean CGI-S of 4.7 (SD = 0.8), and were diagnosed with autistic disorder and comorbid intellectual disability. The mean age was 15.1 years (SD = 10.9), the primary targeted symptoms were agitation/irritability, physical aggression, and self-injury. The majority of patients remained on two or more antipsychotics for >1 year. In this population, patients demonstrated greater symptomatic improvement and generally tolerated treatment without significant adverse effects. The use of two or more antipsychotic medications may be increasingly common in patients with ASD. This retrospective study demonstrates that this treatment approach may be of some clinical benefit, and is generally well

  20. Polyunsaturated fatty acids (PUFAs) for children with specific learning disorders.

    Science.gov (United States)

    Tan, May Loong; Ho, Jacqueline J; Teh, Keng Hwang

    2016-09-28

    About 5% of school children have a specific learning disorder, defined as unexpected failure to acquire adequate abilities in reading, writing or mathematics that is not a result of reduced intellectual ability, inadequate teaching or social deprivation. Of these events, 80% are reading disorders. Polyunsaturated fatty acids (PUFAs), in particular, omega-3 and omega-6 fatty acids, which normally are abundant in the brain and in the retina, are important for learning. Some children with specific learning disorders have been found to be deficient in these PUFAs, and it is argued that supplementation of PUFAs may help these children improve their learning abilities. 1. To assess effects on learning outcomes of supplementation of polyunsaturated fatty acids (PUFAs) for children with specific learning disorders.2. To determine whether adverse effects of supplementation of PUFAs are reported in these children. In November 2015, we searched CENTRAL, Ovid MEDLINE, Embase, PsycINFO, 10 other databases and two trials registers. We also searched the reference lists of relevant articles. Randomised controlled trials (RCTs) or quasi-RCTs comparing PUFAs with placebo or no treatment in children younger than 18 years with specific learning disabilities, as diagnosed in accordance with the fifth (or earlier) edition of theDiagnostic and Statistical Manual of Mental Disorders (DSM-5), or the 10th (or earlier) revision of the International Classification of Diseases (ICD-10) or equivalent criteria. We included children with coexisting developmental disorders such as attention deficit hyperactivity disorder (ADHD) or autism. Two review authors (MLT and KHT) independently screened the titles and abstracts of articles identified by the search and eliminated all studies that did not meet the inclusion criteria. We contacted study authors to ask for missing information and clarification, when needed. We used the GRADE approach to assess the quality of evidence. Two small studies

  1. MEDICAL NUTRITION THERAPY IN MANAGEMENT OF EATING DISORDERS

    Directory of Open Access Journals (Sweden)

    Miloš Pavlović

    2009-01-01

    Full Text Available The treatment of eating disorders demands a comprehensive medical approach, where a dietitian has an important role, primarily due to numerous instances of malnutrition. The objective of this paper was to recapitulate the research findings and clinical evidence which show the importance of medical nutrition therapy in the treatment of eating disorders; furthermore, they present significant guidelines for clinical practice. The research methods have entailed a thorough exploration of literature available at research data bases. The results of the research studies published so far have unambiguously pointed out that, when eating disorders are concerned, there is an urgent need for a diet therapy in order for the patient to restore the appropriate body weight as well as normal eating habits. On the one hand, certain authors suggest returning to normal nutritional habits immediately, whereas, on the other hand, certain others advocate a diet therapy program, that is, a gradual process of recovery. Patients incapable of oral food intake receive enteral nutrition. Parenteral nutrition is applied for recovering the lost electrolytes and fluids, but it should be applied rarely, primarily in states of urgency. For patients suffering from eating disorders the increase in weight indicates good chances of recovery; therefore, the patient’s nutritional status should be carefully and continuously noted. Finally, it is important that our country, too, should adopt a carefully prescribed and conducted diet therapy as an obligatory step in the treatment of patients with eating disorders.

  2. Treatment of Post-Traumatic Stress Disorder Nightmares at a Veterans Affairs Medical Center

    Science.gov (United States)

    Detweiler, Mark B.; Pagadala, Bhuvaneshwar; Candelario, Joseph; Boyle, Jennifer S.; Detweiler, Jonna G.; Lutgens, Brian W.

    2016-01-01

    The effectiveness of medications for PTSD in general has been well studied, but the effectiveness of medicatio.ns prescribed specifically for post-traumatic stress disorder (PTSD) nightmares is less well known. This retrospective chart review examined the efficacy of various medications used in actual treatment of PTSD nightmares at one Veteran Affairs Hospital. Records at the Salem, VA Veterans Affairs Medical Center (VAMC) were examined from 2009 to 2013 to check for the efficacy of actual treatments used in comparis.on with treatments suggested in three main review articles. The final sample consisted of 327 patients and 478 separate medication trials involving 21 individual medications plus 13 different medication combinations. The three most frequently utilized medications were prazosin (107 trials), risperidone (81 trials), and quetiapine (72 trials). Five medications had 20 or more trials with successful results (partial to full nightmare cessation) in >50% of trials: risperidone (77%, 1.0–6.0 mg), clonidine (63%, 0.1–2.0 mg), quetiapine (50%, 12.5–800.0 mg), mirtazapine (50%; 7.5–30.0 mg), and terazosin (64%, 50.0–300.0 mg). Notably, olanzapine (2.5–10.0) was successful (full remission) in all five prescription trials in five separate patients. Based on the clinical results, the use of risperidone, clonidine, terazosin, and olanzapine warrants additional investigation in clinically controlled trials as medications prescribed specifically for PTSD nightmares. PMID:27999253

  3. Neurological Disorders in Medical Use of Cannabis: An Update.

    Science.gov (United States)

    Solimini, Renata; Rotolo, Maria Concetta; Pichini, Simona; Pacifici, Roberta

    2017-01-01

    Medical cannabis is increasingly used as a treatment or adjunct treatment with different levels of efficacy in several neurological disorders or related symptoms (such as multiple sclerosis, autism, Parkinson and Alzheimer disease, Tourette's syndrome, Huntington's disease, neuropathic pain, epilepsy, headache), as well as in other medical conditions (e.g. nausea and vomiting, glaucoma, appetite stimulation, cancer, inflammatory conditions, asthma). Nevertheless, a number of neurological adverse effects from use of medical cannabis on the short- and on the longterm have been reported, in addition to other adverse health events. It has been noticed that the use of medical cannabis can lead to a paradoxical effects depending on the amount of delta-9-tetrahydrocannabinol (THC) -like cannabinoids the preparation contain. Accordingly, some neurological disorders or symptoms (e.g. multiple sclerosis, seizures, epilepsy, headache) may be caused or exacerbated by the same treatment supposed to cure them. The current review presents an update of the neurological adverse effects resulting from the use of cannabis for medical purposes, highlighting the need to weigh the benefits and risks, when using cannabinoidbased treatments. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  4. Specific safety and tolerability considerations in the use of anticonvulsant medications in children

    Directory of Open Access Journals (Sweden)

    Crepeau A

    2012-06-01

    Full Text Available Amy Z Crepeau,1 Brian D Moseley,2 Elaine C Wirrell31Division of Epilepsy, Department of Neurology, Mayo Clinic, 2Department of Neurology, Mayo Clinic, 3Divisions of Epilepsy and Child and Adolescent Neurology, Mayo Clinic, Rochester, MN, USAAbstract: Epilepsy is one of the most common neurological disorders in the pediatric age range, and the majority of affected children can be safely and effectively treated with antiepileptic medication. While there are many antiepileptic agents on the market, specific drugs may be more efficacious for certain seizure types or electroclinical syndromes. Furthermore, certain adverse effects are more common with specific classes of medication. Additionally patient-specific factors, such as age, race, other medical conditions, or concurrent medication use may result in higher rates of side effects or altered efficacy. Significant developmental changes in gastric absorption, protein binding, hepatic metabolism, and renal clearance are seen over the pediatric age range, which impact pharmacokinetics. Such changes must be considered to determine optimal dosing and dosing intervals for children at specific ages. Furthermore, approximately one third of children require polytherapy for seizure control, and many more take concurrent medications for other conditions. In such children, drug–drug interactions must be considered to minimize adverse effects and improve efficacy. This review will address issues of antiepileptic drug efficacy, tolerability and ease of use, pharmacokinetics, and drug–drug interactions in the pediatric age range.Keywords: antiepileptic drugs, drug–drug interactions, pharmacokinetics

  5. Pharmacist's Role in Improving Medication Adherence in Transplant Recipients With Comorbid Psychiatric Disorders.

    Science.gov (United States)

    Khorassani, Farah; Tellier, Shannon; Tsapepas, Demetra

    2018-01-01

    Medication nonadherence rates are high in both the transplant and psychiatric populations. The consequence of medication nonadherence posttransplant is graft rejection and psychiatric decompensation, highlighting the importance of optimizing adherence to medication regimens. Pharmacists may work with transplant patients with psychiatric comorbidity to improve medication adherence through identifying patient-specific barriers and recommending an appropriate intervention. Multiple evidence-based practices for improving nonadherence have been detailed in the transplant and psychiatric population. Medication adherence aids, medication management, patient education, and motivational interviewing are all strategies that may be used to improve adherence. Selecting which interventions to make will be based on the reasons for a patient's nonadherence. Most patients benefit from medication management, patient education, and medication adherence aids. Selection of medication adherence aids may be based on patient demographics, technology literacy, and preference. Motivational interviewing may be considered in patients with intentional nonadherence relating to a lack of insight into their illness or the importance of taking medication. Pharmacists may promote adherence and potentially improve patient outcomes in transplant recipients with comorbid psychiatric disorders through assisting patients with designing a tailored medication adherence plan.

  6. [Multilingualism and child psychiatry: on differential diagnoses of language disorder, specific learning disorder, and selective mutism].

    Science.gov (United States)

    Tamiya, Satoshi

    2014-01-01

    Multilingualism poses unique psychiatric problems, especially in the field of child psychiatry. The author discusses several linguistic and transcultural issues in relation to Language Disorder, Specific Learning Disorder and Selective Mutism. Linguistic characteristics of multiple language development, including so-called profile effects and code-switching, need to be understood for differential diagnosis. It is also emphasized that Language Disorder in a bilingual person is not different or worse than that in a monolingual person. Second language proficiency, cultural background and transfer from the first language all need to be considered in an evaluation for Specific Learning Disorder. Selective Mutism has to be differentiated from the silent period observed in the normal successive bilingual development. The author concludes the review by remarking on some caveats around methods of language evaluation in a multilingual person.

  7. Testing for clinical inertia in medication treatment of bipolar disorder.

    Science.gov (United States)

    Hodgkin, Dominic; Merrick, Elizabeth L; O'Brien, Peggy L; McGuire, Thomas G; Lee, Sue; Deckersbach, Thilo; Nierenberg, Andrew A

    2016-11-15

    Clinical inertia has been defined as lack of change in medication treatment at visits where a medication adjustment appears to be indicated. This paper seeks to identify the extent of clinical inertia in medication treatment of bipolar disorder. A second goal is to identify patient characteristics that predict this treatment pattern. Data describe 23,406 visits made by 1815 patients treated for bipolar disorder during the STEP-BD practical clinical trial. Visits were classified in terms of whether a medication adjustment appears to be indicated, and also whether or not one occurred. Multivariable regression analyses were conducted to find which patient characteristics were predictive of whether adjustment occurred. 36% of visits showed at least 1 indication for adjustment. The most common indications were non-response to medication, side effects, and start of a new illness episode. Among visits with an indication for adjustment, no adjustment occurred 19% of the time, which may be suggestive of clinical inertia. In multivariable models, presence of any indication for medication adjustment was a predictor of receiving one (OR=1.125, 95% CI =1.015, 1.246), although not as strong as clinical status measures. The associations observed are not necessarily causal, given the study design. The data also lack information about physician-patient communication. Many patients remained on the same medication regimen despite indications of side effects or non-response to treatment. Although lack of adjustment does not necessarily reflect clinical inertia in all cases, the reasons for this treatment pattern merit further examination. Copyright © 2016 Elsevier B.V. All rights reserved.

  8. Psychotherapy and medication management strategies for obsessive-compulsive disorder

    Directory of Open Access Journals (Sweden)

    McDougle CJ

    2011-08-01

    Full Text Available Kelda H Walsh, Christopher J McDougleDepartment of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USAAbstract: Obsessive-compulsive disorder (OCD is a chronic anxiety disorder. While medication and psychotherapy advances have been very helpful to patients, many patients do not respond adequately to initial trials of serotonergic medication or cognitive-behavioral therapy (CBT and require multiple treatment trials or combination therapies. Comorbidity may also influence treatment response. The role of streptococcal infections in pediatric OCD has become an area of intense scrutiny and controversy. In this article, current treatment methods for OCD will be reviewed, with special attention to strategies for treating OCD in children and in patients with comorbid tic disorders. Alternative psychotherapy strategies for patients who are highly anxious about starting CBT, such as cognitive therapy or augmentation with D-cycloserine, will be reviewed. Newer issues regarding use of antibiotics, neuroleptics, and glutamate modulators in OCD treatment will also be explored.Keywords: OCD, exposure/response prevention therapy, PANDAS, tic disorder

  9. Relationship between Eating Disorders, Stress and Depression in Medical Students of Lorestan University of Medical Sciences & Health Services

    OpenAIRE

    Afarin Ahmadian

    2016-01-01

    Background & Aim: Nowadays eating disorders are considered as one of the main psychological disorders. These types of disorder result in physical and mental health problems and affect the individuals’ quality of life. This study has aimed to survey eating disorders and its relation with depression and stress in medical students of Lorestan University of Medical Sciences. Methodology: In a descriptive study, 340 university students were chosen by the use of simple random sampling and als...

  10. Job-specific mandatory medical examinations for the police force.

    Science.gov (United States)

    Boschman, J S; Hulshof, C T J; Frings-Dresen, M H W; Sluiter, J K

    2017-08-01

    Mandatory medical examinations (MMEs) of workers should be based on the health and safety requirements that are needed for effectively performing the relevant work. For police personnel in the Netherlands, no job-specific MME exists that takes the specific tasks and duties into account. To provide the Dutch National Police with a knowledge base for job-specific MMEs for police personnel that will lead to equitable decisions from an occupational health perspective about who can perform police duties. We used a stepwise mixed-methods approach in which we included interviews with employees and experts and a review of the national and international literature. We determined the job demands for the various police jobs, determined which were regarded as specific job demands and formulated the matching health requirements as specific as possible for each occupation. A total of 21 specific job demands were considered relevant in different police jobs. These included biomechanical, physiological, physical, emotional, psychological/cognitive and sensory job demands. We formulated both police-generic and job-specific health requirements based on the specific job demands. Two examples are presented: bike patrol and criminal investigation. Our study substantiated the need for job-specific MMEs for police personnel. We found specific job demands that differed substantially for various police jobs. The corresponding health requirements were partly police-generic, and partly job-specific. © The Author 2017. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  11. Are diagnostic criteria for eating disorders markers of medical severity?

    Science.gov (United States)

    Peebles, Rebecka; Hardy, Kristina K; Wilson, Jenny L; Lock, James D

    2010-05-01

    The objective of this study was to compare the medical severity of adolescents who had eating disorders not otherwise specified (EDNOS) with those who had anorexia nervosa (AN) and bulimia nervosa (BN). Medical records of 1310 females aged 8 through 19 years and treated for AN, BN, or EDNOS were retrospectively reviewed. Patients with EDNOS were subcategorized into partial AN (pAN) and partial BN (pBN) when they met all Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria but 1 for AN or BN, respectively. Primary outcome variables were heart rate, systolic blood pressure, temperature, and QTc interval on electrocardiogram. Additional physiologically significant medical complications were also reviewed. A total of 25.2% of females had AN, 12.4% had BN, and 62.4% had EDNOS. The medical severity of patients with EDNOS was intermediate to that of patients with AN and BN in all primary outcomes. Patients with pAN had significantly higher heart rates, systolic blood pressures, and temperatures than those with AN; patients with pBN did not differ significantly from those with BN in any primary outcome variable; however, patients with pAN and pBN differed significantly from each other in all outcome variables. Patients with pBN and BN had longer QTc intervals and higher rates of additional medical complications reported at presentation than other groups. EDNOS is a medically heterogeneous category with serious physiologic sequelae in children and adolescents. Broadening AN and BN criteria in pediatric patients to include pAN and pBN may prove to be clinically useful.

  12. Specificity of abnormal brain volume in major depressive disorder: a comparison with borderline personality disorder.

    Science.gov (United States)

    Depping, Malte S; Wolf, Nadine D; Vasic, Nenad; Sambataro, Fabio; Thomann, Philipp A; Christian Wolf, R

    2015-03-15

    Abnormal brain volume has been frequently demonstrated in major depressive disorder (MDD). It is unclear if these findings are specific for MDD since aberrant brain structure is also present in disorders with depressive comorbidity and affective dysregulation, such as borderline personality disorder (BPD). In this transdiagnostic study, we aimed to investigate if regional brain volume loss differentiates between MDD and BPD. Further, we tested for associations between brain volume and clinical variables within and between diagnostic groups. 22 Females with a DSM-IV diagnosis of MDD, 17 females with a DSM-IV diagnosis of BPD and without comorbid posttraumatic stress disorder, and 22 age-matched female healthy controls (HC) were investigated using magnetic resonance imaging. High-resolution structural data were analyzed using voxel-based morphometry. A significant (pdisorders. Copyright © 2014 Elsevier B.V. All rights reserved.

  13. Working memory deficits in children with specific learning disorders.

    Science.gov (United States)

    Schuchardt, Kirsten; Maehler, Claudia; Hasselhorn, Marcus

    2008-01-01

    This article examines working memory functioning in children with specific developmental disorders of scholastic skills as defined by ICD-10. Ninety-seven second to fourth graders with a minimum IQ of 80 are compared using a 2 x 2 factorial (dyscalculia vs. no dyscalculia; dyslexia vs. no dyslexia) design. An extensive test battery assesses the three subcomponents of working memory described by Baddeley (1986): phonological loop, visual-spatial sketchpad, and central executive. Children with dyscalculia show deficits in visual-spatial memory; children with dyslexia show deficits in phonological and central executive functioning. When controlling for the influence of the phonological loop on the performance of the central executive, however, the effect is no longer significant. Although children with both reading and arithmetic disorders are consistently outperformed by all other groups, there is no significant interaction between the factors dyscalculia and dyslexia.

  14. Psychological Co-morbidity in Children with Specific Learning Disorders.

    Science.gov (United States)

    Sahoo, Manoj K; Biswas, Haritha; Padhy, Susanta Kumar

    2015-01-01

    Children under 19 years of age constitute over 40% of India's population and information about their mental health needs is a national imperative. Children with specific learning disorders (SLDs) exhibit academic difficulties disproportionate to their intellectual capacities. Prevalence of SLD ranges from 2% to 10%. Dyslexia (developmental reading disorder) is the most common type, affecting 80% of all SLD. About 30% of learning disabled children have behavioral and emotional problems, which range from attention deficit hyperactivity disorder (most common) to depression, anxiety, suicide etc., to substance abuse (least common). Co-occurrence of such problems with SLD further adds to the academic difficulty. In such instances, diagnosis is difficult and tricky; improvement in academics demands comprehensive holistic treatment approach. SLD remains a large public health problem because of under-recognition, inadequate treatment and therefore merits greater effort to understand the co-morbidities, especially in the Indian population. As the literature is scarce regarding co-morbid conditions in learning disability in Indian scenario, the present study has tried to focus on Indian population. The educational concessions (recent most) given to such children by Central Board of Secondary Education, New Delhi are referred to. The issues to be addressed by the family physicians are: Low level of awareness among families and teachers, improper dissemination of accurate information about psychological problems, available help seeking avenues, need to develop service delivery models in rural and urban areas and focus on the integration of mental health and primary care keeping such co-morbidity in mind.

  15. Distinguishing medication-free subjects with unipolar disorder from subjects with bipolar disorder: state matters.

    Science.gov (United States)

    Rive, Maria M; Redlich, Ronny; Schmaal, Lianne; Marquand, André F; Dannlowski, Udo; Grotegerd, Dominik; Veltman, Dick J; Schene, Aart H; Ruhé, Henricus G

    2016-11-01

    Recent studies have indicated that pattern recognition techniques of functional magnetic resonance imaging (fMRI) data for individual classification may be valuable for distinguishing between major depressive disorder (MDD) and bipolar disorder (BD). Importantly, medication may have affected previous classification results as subjects with MDD and BD use different classes of medication. Furthermore, almost all studies have investigated only depressed subjects. Therefore, we focused on medication-free subjects. We additionally investigated whether classification would be mood state independent by including depressed and remitted subjects alike. We applied Gaussian process classifiers to investigate the discriminatory power of structural MRI (gray matter volumes of emotion regulation areas) and resting-state fMRI (resting-state networks implicated in mood disorders: default mode network [DMN], salience network [SN], and lateralized frontoparietal networks [FPNs]) in depressed (n=42) and remitted (n=49) medication-free subjects with MDD and BD. Depressed subjects with MDD and BD could be classified based on the gray matter volumes of emotion regulation areas as well as DMN functional connectivity with 69.1% prediction accuracy. Prediction accuracy using the FPNs and SN did not exceed chance level. It was not possible to discriminate between remitted subjects with MDD and BD. For the first time, we showed that medication-free subjects with MDD and BD can be differentiated based on structural MRI as well as resting-state functional connectivity. Importantly, the results indicated that research concerning diagnostic neuroimaging tools distinguishing between MDD and BD should consider mood state as only depressed subjects with MDD and BD could be correctly classified. Future studies, in larger samples are needed to investigate whether the results can be generalized to medication-naïve or first-episode subjects. © 2016 John Wiley & Sons A/S. Published by John Wiley

  16. Korean Medication Algorithm for Depressive Disorders 2017: Third Revision

    Science.gov (United States)

    Seo, Jeong Seok; Wang, Hee Ryung; Woo, Young Sup; Park, Young-Min; Jeong, Jong-Hyun; Kim, Won; Shim, Se-Hoon; Lee, Jung Goo; Jon, Duk-In

    2018-01-01

    Objective In 2002, the Korean Society for Affective Disorders developed the guidelines for the treatment of major depressive disorder (MDD), and revised it in 2006 and 2012. The third revision of these guidelines was undertaken to reflect advances in the field. Methods Using a 44-item questionnaire, an expert consensus was obtained on pharmacological treatment strategies for MDD 1) without or 2) with psychotic features, 3) depression subtypes, 4) maintenance, 5) special populations, 6) the choice of an antidepressant (AD) regarding safety and adverse effects, and 7) non-pharmacological biological therapies. Recommended first, second, and third-line strategies were derived statistically. Results AD monotherapy is recommended as the first-line strategy for non-psychotic depression in adults, children/adolescents, elderly adults, patient with persistent depressive disorder, and pregnant women or patients with postpartum depression or premenstrual dysphoric disorder. The combination of AD and atypical antipsychotics (AAP) was recommended for psychotic depression in adult, child/adolescent, postpartum depression, and mixed features or anxious distress. Most experts recommended stopping the ongoing initial AD and AAP after a certain period in patients with one or two depressive episodes. As an MDD treatment modality, 92% of experts are considering electroconvulsive therapy and 46.8% are applying it clinically, while 86% of experts are considering repetitive transcranial magnetic stimulation but only 31.6% are applying it clinically. Conclusion The pharmacological treatment strategy in 2017 is similar to that of Korean Medication Algorithm for Depressive Disorder 2012. The preference of AAPs was more increased. PMID:29397669

  17. Social support and common mental disorder among medical students

    Directory of Open Access Journals (Sweden)

    Adriano Gonçalves Silva

    2014-03-01

    Full Text Available INTRODUCTION: Different kinds of psychological distress have been identified for students in the health field, especially in the medical school. OBJECTIVE: To estimate the prevalence of mental suffering among medical students in the Southeastern Brazil and asses its association with social support. METHODS: It is a cross-sectional study. Structured questionnaires were applied for students from the 1st up to the 6th years of the medical school of Universidade Estadual Paulista "Júlio de Mesquita Filho", assessing demographic variables related to aspects of graduation and adaptation to the city. Psychological suffering was defined as a common mental disorder (CMD assessed by the Self Reporting Questionnaire (SRQ-20. Social support was assessed by the social support scale of the Medical Outcomes Study (MOS. The association between the outcome and explanatory variables was assessed by the χ2 test and Logistic Regression, for the multivariate analyses, using p < 0.05. RESULTS: The response rate was of 80.7%, with no differences between sample and the population regarding gender (p = 0.78. The average age was 22 years old (standard deviation - SD = 2.2, mainly women (58.2% and students who were living with friends (62%. The prevalence of CMD was 44.9% (95%CI 40.2 - 49.6. After the multivariate analyses, the explanatory variables that were associated with CMD were: feeling rejected in the past year (p < 0.001, thinking about leaving medical school (p < 0.001 and "interaction" in the MOS scale (p = 0.002. CONCLUSIONS: The prevalence of CMD among medical students was high and insufficient social support was an important risk factor. Our findings suggest that interventions to improve social interaction among those students could be beneficial, decreasing the prevalence of CMD in this group.

  18. Social support and common mental disorder among medical students.

    Science.gov (United States)

    Silva, Adriano Gonçalves; Cerqueira, Ana Teresa de Abreu Ramos; Lima, Maria Cristina Pereira

    2014-01-01

    Different kinds of psychological distress have been identified for students in the health field, especially in the medical school. To estimate the prevalence of mental suffering among medical students in the Southeastern Brazil and asses its association with social support. It is a cross-sectional study. Structured questionnaires were applied for students from the 1st up to the 6th years of the medical school of Universidade Estadual Paulista "Júlio de Mesquita Filho", assessing demographic variables related to aspects of graduation and adaptation to the city. Psychological suffering was defined as a common mental disorder (CMD) assessed by the Self Reporting Questionnaire (SRQ-20). Social support was assessed by the social support scale of the Medical Outcomes Study (MOS). The association between the outcome and explanatory variables was assessed by the χ2 test and Logistic Regression, for the multivariate analyses, using p < 0.05. The response rate was of 80.7%, with no differences between sample and the population regarding gender (p = 0.78). The average age was 22 years old (standard deviation - SD = 2.2), mainly women (58.2%) and students who were living with friends (62%). The prevalence of CMD was 44.9% (95%CI 40.2 - 49.6). After the multivariate analyses, the explanatory variables that were associated with CMD were: feeling rejected in the past year (p < 0.001), thinking about leaving medical school (p < 0.001) and "interaction" in the MOS scale (p = 0.002). The prevalence of CMD among medical students was high and insufficient social support was an important risk factor. Our findings suggest that interventions to improve social interaction among those students could be beneficial, decreasing the prevalence of CMD in this group.

  19. Caloric vestibular stimulation as a treatment for conversion disorder: A case report and medical hypothesis

    Directory of Open Access Journals (Sweden)

    Michael eNoll-Hussong

    2014-06-01

    Full Text Available Conversion disorder is a medical condition in which a person has paralysis, blindness, or other neurological symptoms that cannot be clearly explained physiologically. To date, there is neither specific nor conclusive treatment. In this paper, we draw together a number of disparate pieces of knowledge to propose a novel intervention to provide transient alleviation for this condition. As caloric vestibular stimulation (CVS has been demonstrated to modulate transiently a variety of cognitive functions associated with brain activations, especially in the temporal-parietal cortex, anterior cingulate cortex, and insular cortex, there is evidence to assume an effect in specific mental disorders. Therefore, we go on to hypothesize that lateralized cold vestibular caloric stimulation will be effective in treating conversion disorder and we present provisional evidence from one patient that supports this conclusion. If our hypothesis is correct, this will be the first time in psychiatry and neurology that a clinically well-known mental disorder, long considered difficult to understand and to treat, is relieved by a simple or common, non-invasive medical procedure.

  20. Psychological Variables for Identifying Susceptibility to Mental Disorders in Medical

    Directory of Open Access Journals (Sweden)

    Rosa Sender

    2004-05-01

    Full Text Available Introduction: This study analyses some psychological variables related to susceptibility to mental disorders in medical students. Methods: A sample of 209 first- and second-year medical students was evaluated using the State and Trait Anxiety Inventory (STAI, and three questionnaires: Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSRQ, General Health Questionnaire (GHQ-28 and UNCAHS scale of STRAIN. Results: Thirty percent of the students suffered from emotional distress as measured by de GHQ-28, and showed significantly higher scores on trait anxiety, sensitivity to punishment and reward scales, and had higher levels of strain both in the academic environment and their personal life. Women scored significantly higher than men on trait anxiety and sensitivity to reward. Logistical regression found that trait anxiety and strain in non-academic life were the best predictors of the development of a mental disorder. Conclusions: The study confirms the usefulness of the STAI for detecting psychological distress and the validity of the SPSRQ for identifying subjects likely to present emotional distress when facing high environmental demands. Subjects most likely to present with mental illness are those who evaluate their personal (non-academic lives as more stressful.

  1. Medical marijuana for digestive disorders: high time to prescribe?

    Science.gov (United States)

    Gerich, Mark E; Isfort, Robert W; Brimhall, Bryan; Siegel, Corey A

    2015-02-01

    The use of recreational and medical marijuana is increasingly accepted by the general public in the United States. Along with growing interest in marijuana use has come an understanding of marijuana's effects on normal physiology and disease, primarily through elucidation of the human endocannabinoid system. Scientific inquiry into this system has indicated potential roles for marijuana in the modulation of gastrointestinal symptoms and disease. Some patients with gastrointestinal disorders already turn to marijuana for symptomatic relief, often without a clear understanding of the risks and benefits of marijuana for their condition. Unfortunately, that lack of understanding is shared by health-care providers. Marijuana's federal legal status as a Schedule I controlled substance has limited clinical investigation of its effects. There are also potential legal ramifications for physicians who provide recommendations for marijuana for their patients. Despite these constraints, as an increasing number of patients consider marijuana as a potential therapy for their digestive disorders, health-care providers will be asked to discuss the issues surrounding medical marijuana with their patients.

  2. Basic number processing in children with specific learning disorders: Comorbidity of reading and mathematics disorders.

    Science.gov (United States)

    Moll, Kristina; Göbel, Silke M; Snowling, Margaret J

    2015-01-01

    As well as being the hallmark of mathematics disorders, deficits in number processing have also been reported for individuals with reading disorders. The aim of the present study was to investigate separately the components of numerical processing affected in reading and mathematical disorders within the framework of the Triple Code Model. Children with reading disorders (RD), mathematics disorders (MD), comorbid deficits (RD + MD), and typically developing children (TD) were tested on verbal, visual-verbal, and nonverbal number tasks. As expected, children with MD were impaired across a broad range of numerical tasks. In contrast, children with RD were impaired in (visual-)verbal number tasks but showed age-appropriate performance in nonverbal number skills, suggesting their impairments were domain specific and related to their reading difficulties. The comorbid group showed an additive profile of the impairments of the two single-deficit groups. Performance in speeded verbal number tasks was related to rapid automatized naming, a measure of visual-verbal access in the RD but not in the MD group. The results indicate that deficits in number skills are due to different underlying cognitive deficits in children with RD compared to children with MD: a phonological deficit in RD and a deficit in processing numerosities in MD.

  3. Psychotropic medication management in persons with co-occurring psychiatric and substance use disorders.

    Science.gov (United States)

    Sowers, W; Golden, S

    1999-01-01

    Persons presenting with concurrent psychiatric and substance problems present unique challenges for diagnosis and for effective and rational treatment planning. This is especially true for psychiatrists attempting to prescribe pharmacologic interventions which will promote recovery from both disorders and improve function. In order to be effective in this endeavor it is important to have a clear understanding of the dynamics of addiction as well as the particular issues and struggles related to mental illness which will affect an individual's attitude toward and use of medication. This article discusses some of the common problems related to diagnostic decision making and initiation of medication in persons with co-occurring disorders. An algorithm for guiding these decisions is presented. Common misconceptions held by these individuals regarding medication, as distinguished from "drugs," are considered. Unique psychodynamic issues that may lead these persons to actively seek medication as a solution to their problems, or which may, conversely, lead them to an outright rejection of medication as a part of their recovery, are discussed. Countertransferential issues influencing the physician's approach to prescribing for this population are also considered. The article concludes with recommendations for pharmacologic approaches to address specific psychiatric syndromes which may present in this population.

  4. 78 FR 7967 - Revised Medical Criteria for Evaluating Respiratory System Disorders

    Science.gov (United States)

    2013-02-04

    ... medical terminology for this disorder. We explain the nature of the disorder and our documentation... cause, to reflect current medical terminology. We propose to remove the criterion for arterial hypoxemia... evaluate it?). The change would reflect current medical terminology. There have been advances in the...

  5. Psychological co-morbidity in children with specific learning disorders

    Directory of Open Access Journals (Sweden)

    Manoj K Sahoo

    2015-01-01

    Full Text Available Children under 19 years of age constitute over 40% of India′s population and information about their mental health needs is a national imperative. Children with specific learning disorders (SLDs exhibit academic difficulties disproportionate to their intellectual capacities. Prevalence of SLD ranges from 2% to 10%. Dyslexia (developmental reading disorder is the most common type, affecting 80% of all SLD. About 30% of learning disabled children have behavioral and emotional problems, which range from attention deficit hyperactivity disorder (most common to depression, anxiety, suicide etc., to substance abuse (least common. Co-occurrence of such problems with SLD further adds to the academic difficulty. In such instances, diagnosis is difficult and tricky; improvement in academics demands comprehensive holistic treatment approach. SLD remains a large public health problem because of under-recognition, inadequate treatment and therefore merits greater effort to understand the co-morbidities, especially in the Indian population. As the literature is scarce regarding co-morbid conditions in learning disability in Indian scenario, the present study has tried to focus on Indian population. The educational concessions (recent most given to such children by Central Board of Secondary Education, New Delhi are referred to. The issues to be addressed by the family physicians are: Low level of awareness among families and teachers, improper dissemination of accurate information about psychological problems, available help seeking avenues, need to develop service delivery models in rural and urban areas and focus on the integration of mental health and primary care keeping such co-morbidity in mind.

  6. Application of medical cannabis in patients with the neurodegeneration disorders

    Directory of Open Access Journals (Sweden)

    Lidia Kotuła

    2014-04-01

    Full Text Available Medical cannabis is the dried flowers of the female Cannabis sativa L. plant. Cannabis contains a number of active elements, including dronabinol (THC and cannabidiol (CBD. Dronabinol is usually the main ingredient. The body’s own cannabinoid system has been identified. The discovery of this system, which comprises endocannabinoids and receptors, confirmed that cannabis has a positive effect on certain illnesses and conditions. Two types of cannabinoid receptors have been identified: CB1 and CB2 receptors. The first type CB1 is mostly found in the central nervous system, modulate pain. It also has an anti-emetic effect, and has influence on the memory and the motor system. The second type of receptors CB2 is peripheral, and it is primarily found in immune system cells and it is responsible for the immunomodulatory effects of cannabinoids. Medical cannabis can help in cases of the neurodegeneration disorders, for example Parkinson’s disease, Huntington’s Disease, Amyotrophic Lateral Sclerosis. Patients generally tolerate medical cannabis well.

  7. BORDERLINE PERSONALITY DISORDER IN THE MEDICAL SETTING: Suggestive Behaviors, Syndromes, and Diagnoses.

    Science.gov (United States)

    Sansone, Randy A; Sansone, Lori A

    2015-01-01

    Borderline personality disorder is a personality dysfunction that is characterized by disinhibition and impulsivity, which oftentimes manifest as self-regulation difficulties. Patients with this disorder have always been present in medical settings, but have been described as "difficult patients" rather than patients with borderline personality disorder. According to empirical findings, a number of behaviors and medical syndromes/diagnoses are suggestive of borderline personality disorder. Suggestive behaviors in the medical setting may include aggressive or disruptive behaviors, the intentional sabotage of medical care, and excessive healthcare utilization. Suggestive medical syndromes and diagnoses in the medical setting may include alcohol and substance misuse (including the abuse of prescription medications), multiple somatic complaints, chronic pain, obesity, sexual impulsivity, and hair pulling. While not all-inclusive or diagnostic, these behaviors and syndromes/diagnoses may invite further clinical evaluation of the patient for borderline personality disorder.

  8. Beliefs About GI Medications and Adherence to Pharmacotherapy in Functional GI Disorder Outpatients

    Science.gov (United States)

    Cassell, Benjamin; Gyawali, C. Prakash; Kushnir, Vladimir M.; Gott, Britt M.; Nix, Billy D.; Sayuk, Gregory S.

    2016-01-01

    OBJECTIVES Pharmacotherapy is a mainstay in functional gastrointestinal (GI) disorder (FGID) management, but little is known about patient attitudes toward medication regimens. Understanding patient concerns and adherence to pharmacotherapy is particularly important for off-label medication use (e.g., anti-depressants) in FGID. METHODS Consecutive tertiary GI outpatients completed the Beliefs About Medications questionnaire (BMQ). Subjects were categorized as FGID and structural GI disease (SGID) using clinician diagnoses and Rome criteria; GI-specific medications and doses were recorded, and adherence to medication regimens was determined by patient self-report. BMQ domains (overuse, harm, necessity, and concern) were compared between FGID and SGID, with an interest in how these beliefs affected medication adherence. Psychiatric measures (depression, anxiety, and somatization) were assessed to gauge their influence on medication beliefs. RESULTS A total of 536 subjects (mean age 54.7±0.7 years, range 22–100 years; n=406, 75.7% female) were enrolled over a 5.5-year interval: 341 (63.6%) with FGID (IBS, 64.8%; functional dyspepsia, 51.0%, ≥2 FGIDs, 38.7%) and 142 (26.5%) with SGID (IBD, 28.9%; GERD, 23.2%). PPIs (n=231, 47.8%), tricyclic antidepressants (TCAs) (n=167, 34.6%), and anxiolytics (n=122, 25.3%) were common medications prescribed. FGID and SGID were similar across all BMQ domains (P>0.05 for overuse, harm, necessity, and concern). SGID subjects had higher necessity-concern framework (NCF) scores compared with FGID subjects ( P=0.043). FGID medication adherence correlated negatively with concerns about medication harm (r=−0.24, P<0.001) and overuse (r=−0.15, P=0.001), whereas higher NCF differences predicted medication compliance (P=0.006). Medication concern and overuse scores correlated with psychiatric comorbidity among FGID subjects (P<0.03 for each). FGID patients prescribed TCAs (n=142, 41.6%) expressed a greater medication necessity (17.4

  9. Do current national and international guidelines have specific recommendations for older adults with bipolar disorder?

    DEFF Research Database (Denmark)

    Dols, Annemiek; Kessing, Lars Vedel; Strejilevich, Sergio A

    2016-01-01

    a variety of sources have become available in recent years. It is expected that at least some of this emerging information on OABD would be incorporated into treatment guidelines available to clinicians around the world. METHODS: The International Society of Bipolar Disorders OABD task force compiled...... and compared recommendations from current national and international guidelines that specifically address geriatric or older individuals with BD (from year 2005 onwards). RESULTS: There were 34 guidelines, representing six continents and 19 countries. The majority of guidelines had no separate section on OABD....... General principles for treating OABD with medication are recommended to be similar to those for younger adults, with special caution for side effects due to somatic comorbidity and concomitant medications. Therapeutic lithium serum levels are suggested to be lower but recommendations are very general...

  10. A specific deficit of imitation in autism spectrum disorder.

    Science.gov (United States)

    Stewart, Hannah J; McIntosh, Rob D; Williams, Justin H G

    2013-12-01

    Imitation is a potentially crucial aspect of social cognitive development. Although deficits in imitation ability have been widely demonstrated in autism spectrum disorder (ASD), the specificity and significance of the findings is unclear, due largely to methodological limitations. We developed a novel assessment of imitation ability, using objective movement parameters (path length and action duration) derived from a touch-sensitive tablet laptop during drawing actions on an identical tablet. By direct comparison of the kinematics of a model's actions with those of the participant who observed them, measures of imitation accuracy were obtained. By replaying the end-point of the movement as a spot on the screen, imitation accuracy was compared against a "ghost control" condition, with no human actor but only the end-point of the movement seen [object movement reenactment (OMR)]. Hence, demands of the control task were closely matched to the experimental task with respect to motor, memory, and attentional abilities. Adolescents with ASD showed poorer accuracy for copying object size and action duration on both the imitation and OMR tasks, but were significantly more impaired for imitation of object size. Our results provide evidence that some of the imitation deficit in ASD is specific to a self-other mapping problem, and cannot be explained by general factors such as memory, spatial reasoning, motor control, or attention, nor related to the social demands of the testing situation. © 2013 International Society for Autism Research, Wiley Periodicals, Inc.

  11. Korean Medication Algorithm Project for Bipolar Disorder: third revision.

    Science.gov (United States)

    Woo, Young Sup; Lee, Jung Goo; Jeong, Jong-Hyun; Kim, Moon-Doo; Sohn, Inki; Shim, Se-Hoon; Jon, Duk-In; Seo, Jeong Seok; Shin, Young-Chul; Min, Kyung Joon; Yoon, Bo-Hyun; Bahk, Won-Myong

    2015-01-01

    To constitute the third revision of the guidelines for the treatment of bipolar disorder issued by the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP 2014). A 56-item questionnaire was used to obtain the consensus of experts regarding pharmacological treatment strategies for the various phases of bipolar disorder and for special populations. The review committee included 110 Korean psychiatrists and 38 experts for child and adolescent psychiatry. Of the committee members, 64 general psychiatrists and 23 child and adolescent psychiatrists responded to the survey. The treatment of choice (TOC) for euphoric, mixed, and psychotic mania was the combination of a mood stabilizer (MS) and an atypical antipsychotic (AAP); the TOC for acute mild depression was monotherapy with MS or AAP; and the TOC for moderate or severe depression was MS plus AAP/antidepressant. The first-line maintenance treatment following mania or depression was MS monotherapy or MS plus AAP; the first-line treatment after mania was AAP monotherapy; and the first-line treatment after depression was lamotrigine (LTG) monotherapy, LTG plus MS/AAP, or MS plus AAP plus LTG. The first-line treatment strategy for mania in children and adolescents was MS plus AAP or AAP monotherapy. For geriatric bipolar patients, the TOC for mania was AAP/MS monotherapy, and the TOC for depression was AAP plus MS or AAP monotherapy. The expert consensus in the KMAP-BP 2014 differed from that in previous publications; most notably, the preference for AAP was increased in the treatment of acute mania, depression, and maintenance treatment. There was increased expert preference for the use of AAP and LTG. The major limitation of the present study is that it was based on the consensus of Korean experts rather than on experimental evidence.

  12. 77 FR 56717 - Specifications for Medical Examinations of Underground Coal Miners

    Science.gov (United States)

    2012-09-13

    ... CFR Part 37 Specifications for Medical Examinations of Underground Coal Miners; Final Rule #0;#0... 0920-AA21 Specifications for Medical Examinations of Underground Coal Miners AGENCY: Centers for... medical examinations of underground coal miners. Existing regulations established specifications for...

  13. The Specificity of Health-Related Autobiographical Memories in Patients With Somatic Symptom Disorder.

    Science.gov (United States)

    Walentynowicz, Marta; Raes, Filip; Van Diest, Ilse; Van den Bergh, Omer

    2017-01-01

    Patients with somatic symptom disorder (SSD) have persistent distressing somatic symptoms that are associated with excessive thoughts, feelings, and behaviors. Reduced autobiographical memory specificity (rAMS) is related to a range of emotional disorders and is considered a vulnerability factor for an unfavorable course of pathology. The present study investigated whether the specificity of health-related autobiographical memories is reduced in patients with SSD with medically unexplained dyspnea complaints, compared with healthy controls. Female patients with SSD (n = 30) and matched healthy controls (n = 24) completed a health-related Autobiographical Memory Test, the Beck Depression Inventory, the Ruminative Response Scale, and rumination scales concerning bodily reactions. Depressive symptoms and rumination were assessed because both variables previously showed associations with rAMS. Patients with SSD recalled fewer specific (F(1,52) = 13.63, p = .001) and more categoric (F(1,52) = 7.62, p = .008) autobiographical memories to health-related cue words than healthy controls. Patients also reported higher levels of depressive symptoms and rumination (all t > 3.00, p < .01). Importantly, the differences in memory specificity were independent of depressive symptoms and trait rumination. The present study extends findings on rAMS to a previously unstudied sample of patients with SSD. Importantly, the presence of rAMS could not be explained by increased levels of depressive symptoms and rumination. We submit that rAMS in this group reflects how health-related episodes and associated symptoms are encoded in memory.

  14. Female medical students are estimated to have a higher risk for developing eating disorders than male medical students

    DEFF Research Database (Denmark)

    Dissing, Nete; Bak, Nanna Hasle; Pedersen, Laura Erna Toftegaard

    2011-01-01

    Studies show that university students are at risk for eating disorders. However, risk behaviour has not been studied among Danish medical students, nor have the gender differences in risk behaviour been described in a Danish context....

  15. The expanding cognitive-behavioural therapy treatment umbrella for the anxiety disorders: disorder-specific and transdiagnostic approaches.

    Science.gov (United States)

    Rector, Neil A; Man, Vincent; Lerman, Bethany

    2014-06-01

    Cognitive-behavioural therapy (CBT) is an empirically supported treatment for anxiety disorders. CBT treatments are based on disorder-specific protocols that have been developed to target individual anxiety disorders, despite that anxiety disorders frequently co-occur and are comorbid with depression. Given the high rates of diagnostic comorbidity, substantial overlap in dimensional symptom ratings, and extensive evidence that the mood and anxiety disorders share a common set of psychological and biological vulnerabilities, transdiagnostic CBT protocols have recently been developed to treat the commonalities among the mood and anxiety disorders. We conducted a selective review of empirical developments in the transdiagnostic CBT treatment of anxiety and depression (2008-2013). Preliminary evidence suggests that theoretically based transdiagnostic CBT approaches lead to large treatment effects on the primary anxiety disorder, considerable reduction of diagnostic comorbidity, and some preliminary effects regarding the impact on the putative, shared psychological mechanisms. However, the empirical literature remains tentative owing to relatively small samples, limited direct comparisons with disorder-specific CBT protocols, and the relative absence of the study of disorder-specific compared with shared mechanisms of action in treatment. We conclude with a treatment conceptualization of the new transdiagnostic interventions as complementary, rather than contradictory, to disorder-specific CBT.

  16. Does major depressive disorder in parents predict specific fears and phobias in offspring?

    Science.gov (United States)

    Biel, Matthew G; Klein, Rachel G; Mannuzza, Salvatore; Roizen, Erica R; Truong, Nhan L; Roberson-Nay, Roxann; Pine, Daniel S

    2008-01-01

    Evidence suggests a relationship between parental depression and phobias in offspring as well as links between childhood fears and risk for major depression. This study examines the relationship between major depressive disorder (MDD) and anxiety disorders in parents and specific fears and phobias in offspring. Three hundred and eighteen children of parents with lifetime MDD, anxiety disorder, MDD+anxiety disorder, or neither were psychiatrically assessed via parent interview. Rates of specific phobias in offspring did not differ significantly across parental groups. Specific fears were significantly elevated in offspring of parents with MDD+anxiety disorder relative to the other groups (MDD, anxiety disorder, and controls, which did not differ). We failed to find increased phobias in offspring of parents with MDD without anxiety disorder. Elevated rates of specific fears in offspring of parents with MDD+anxiety disorder may be a function of more severe parental psychopathology, increased genetic loading, or unmeasured environmental influences. (c) 2007 Wiley-Liss, Inc.

  17. [Security specifications for electronic medical records on the Internet].

    Science.gov (United States)

    Mocanu, Mihai; Mocanu, Carmen

    2007-01-01

    The extension for the Web applications of the Electronic Medical Record seems both interesting and promising. Correlated with the expansion of Internet in our country, it allows the interconnection of physicians of different specialties and their collaboration for better treatment of patients. In this respect, the ophthalmologic medical applications consider the increased possibilities for monitoring chronic ocular diseases and for the identification of some elements for early diagnosis and risk factors supervision. We emphasize in this survey some possible solutions to the problems of interconnecting medical information systems to the Internet: the achievement of interoperability within medical organizations through the use of open standards, the automated input and processing for ocular imaging, the use of data reduction techniques in order to increase the speed of image retrieval in large databases, and, last but not least, the resolution of security and confidentiality problems in medical databases.

  18. Gender-specific predictors of posttraumatic stress disorder in adolescents

    DEFF Research Database (Denmark)

    Donbaek, Dagmar Feddern; Elklit, Ask

    2015-01-01

    Gender is an important risk factor for both posttraumatic stress disorder (PTSD) and substance use disorders (SUD) in adolescents; however, little is known about the influence of gender when considering their common co-occurrence. This study examined whether problematic substance use, attachment...

  19. Risperidone added to parent training and stimulant medication: effects on attention-deficit/hyperactivity disorder, oppositional defiant disorder, conduct disorder, and peer aggression.

    Science.gov (United States)

    Gadow, Kenneth D; Arnold, L Eugene; Molina, Brooke S G; Findling, Robert L; Bukstein, Oscar G; Brown, Nicole V; McNamara, Nora K; Rundberg-Rivera, E Victoria; Li, Xiaobai; Kipp, Heidi L; Schneider, Jayne; Farmer, Cristan A; Baker, Jennifer L; Sprafkin, Joyce; Rice, Robert R; Bangalore, Srihari S; Butter, Eric M; Buchan-Page, Kristin A; Hurt, Elizabeth A; Austin, Adrienne B; Grondhuis, Sabrina N; Aman, Michael G

    2014-09-01

    In this study, we aimed to expand on our prior research into the relative efficacy of combining parent training, stimulant medication, and placebo (Basic therapy) versus parent training, stimulant, and risperidone (Augmented therapy) by examining treatment effects for attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD) symptoms and peer aggression, symptom-induced impairment, and informant discrepancy. Children (6-12 years of age; N = 168) with severe physical aggression, ADHD, and co-occurring ODD/CD received an open trial of parent training and stimulant medication for 3 weeks. Participants failing to show optimal clinical response were randomly assigned to Basic or Augmented therapy for an additional 6 weeks. Compared with Basic therapy, children receiving Augmented therapy experienced greater reduction in parent-rated ODD severity (p = .002, Cohen's d = 0.27) and peer aggression (p = .02, Cohen's d = 0.32) but not ADHD or CD symptoms. Fewer children receiving Augmented (16%) than Basic (40%) therapy were rated by their parents as impaired by ODD symptoms at week 9/endpoint (p = .008). Teacher ratings indicated greater reduction in ADHD severity (p = .02, Cohen's d = 0.61) with Augmented therapy, but not for ODD or CD symptoms or peer aggression. Although both interventions were associated with marked symptom reduction, a relatively large percentage of children were rated as impaired for at least 1 targeted disorder at week 9/endpoint by parents (Basic 47%; Augmented 27%) and teachers (Basic 48%; Augmented 38%). Augmented therapy was superior to Basic therapy in reducing severity of ADHD and ODD symptoms, peer aggression, and symptom-induced impairment, but clinical improvement was generally context specific, and effect sizes ranged from small to moderate. Clinical trial registration information-Treatment of Severe Childhood Aggression (The TOSCA Study); http://clinicaltrials.gov/; NCT00796302

  20. Psychiatric Comorbidity and Medication Use in Adults with Autism Spectrum Disorder

    Science.gov (United States)

    Buck, Tara R.; Viskochil, Joseph; Farley, Megan; Coon, Hilary; McMahon, William M.; Morgan, Jubel; Bilder, Deborah A.

    2014-01-01

    The purpose of this study was to investigate comorbid psychiatric disorders and psychotropic medication use among adults with autism spectrum disorder (ASD) ascertained as children during a 1980's statewide Utah autism prevalence study (n = 129). Seventy-three individuals (56.6%) met criteria for a current psychiatric disorder; 89 participants…

  1. Medications for addiction treatment: an opportunity for prescribing clinicians to facilitate remission from alcohol and opioid use disorders.

    Science.gov (United States)

    Park, Tae Woo; Friedmann, Peter D

    2014-10-01

    Substance use disorders are a leading cause of morbidity and mortality in the United States. Medications for the treatment of substance use disorders are effective yet underutilized. This article reviews recent literature examining medications used for the treatment of alcohol and opioid use disorders. The neurobehavioral rationale for medication treatment and the most common ways medications work in the treatment of substance use disorders are discussed. Finally, the medications and the evidence behind their effectiveness are briefly reviewed. Physicians and other prescribing clinicians should take an active role in facilitating remission and recovery from substance use disorders by prescribing these effective medications with brief medical management counseling.

  2. Self-medication of mood and anxiety disorders with marijuana: Higher in states with medical marijuana laws.

    Science.gov (United States)

    Sarvet, Aaron L; Wall, Melanie M; Keyes, Katherine M; Olfson, Mark; Cerdá, Magdalena; Hasin, Deborah S

    2018-05-01

    Self-medication with drugs or alcohol is commonly reported among adults with mood or anxiety disorders, and increases the risk of developing substance use disorders. Medical marijuana laws (MML) may be associated with greater acceptance of the therapeutic value of marijuana, leading individuals to self-medicate. The study utilized data from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (2004-2005). Participants were sampled from households in the general population and included adults with a mood or anxiety disorder in the past 12 months (n = 7418), and the subset of those who used marijuana and no other drug (n = 314). Weighted logistic regression models predicted the prevalence of self-medication with drugs in U.S. states with and without MML, adjusting for individual and state-level covariates. As a negative control, analyses were repeated for self-medication with alcohol. Overall, self-medication with drugs was 3.73 percentage points higher (95% confidence interval [CI]: 0.93-6.53) among those living in MML states (p = 0.01). For the subpopulation that only used marijuana, self-medication with drugs was 21.22 percentage points higher (95% CI: 3.91-38.53) among those living in MML states (p = 0.02). In contrast, self-medication with alcohol had nearly identical prevalence in MML and non-MML states, overall and for drinkers. Among adults with mood or anxiety disorders, living in a medical marijuana law state is associated with self-medication with marijuana. While additional research is needed to determine the reasons for this association, clinical screening for self-medication with marijuana may be particularly important in states with medical marijuana laws. Copyright © 2018 Elsevier B.V. All rights reserved.

  3. Mental condition and specificity of mental disorders in a group of workers from southern Poland: A research report.

    Science.gov (United States)

    Izydorczyk, Bernadetta

    2018-01-01

    The aim of this work is to provide empirical evidence regarding types and increasing prevalence of mental disorders affecting Polish working population in the years 2014-2016. The research questions concerned the specific characteristics of the types of mental disorders and their prevalence as well as the differences between males and females. Types of mental disorders were investigated using a clinical method, a structured interview, as well as medical record data gathered in the years 2014-2016 in one mental health treatment center. The study was conducted in the population of 1578 working individuals aged 18-64 years old, in various forms of employment, including flexible employment (self-employment, task assignment agreement) and contract employment. The research population consisted of 998 females and 580 males, aged 18-64 years old. The study aimed at investigating types and the prevalence rate of mental disorders developed in the examined working Poles, also with reference to the sex of the study participants as well as the age at which they started seeking treatment. The prevailing disorders include neurotic disorders; diagnosed according to the 10th Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) classification as a range of anxiety disorders, mixed anxiety-depressive disorders, stress-related and somatoform disorders; as well as personality disorders. The prevalence rate of the aforementioned disorders was found to be higher among working females than in the group of working males. The overall study conclusions based on the research data analysis point to the fact that the prevalence rate of various types of mental disorders displayed by the examined working males and females increased significantly in the years 2014-2016. Med Pr 2018;69(1):13-28. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

  4. Korean Medication Algorithm Project for Bipolar Disorder: third revision

    Directory of Open Access Journals (Sweden)

    Woo YS

    2015-02-01

    Full Text Available Young Sup Woo,1 Jung Goo Lee,2,3 Jong-Hyun Jeong,1 Moon-Doo Kim,4 Inki Sohn,5 Se-Hoon Shim,6 Duk-In Jon,7 Jeong Seok Seo,8 Young-Chul Shin,9 Kyung Joon Min,10 Bo-Hyun Yoon,11 Won-Myong Bahk1 1Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, South Korea; 2Department of Psychiatry, Inje University Haeundae Paik Hospital, Busan, South Korea;3Paik Institute for Clinical Research, Inje Univeristy, Busan, South Korea; 4Department of Psychiatry, Jeju National University Hospital, Jeju, South Korea; 5Department of Psychiatry, Keyo Hospital, Keyo Medical Foundation, Uiwang, South Korea; 6Department of Psychiatry, Soonchunhyang University Cheonan Hospital, Soonchunhyang University, Cheonan, South Korea; 7Department of Psychiatry, Sacred Heart Hospital, Hallym University, Anyang, South Korea; 8Department of Psychiatry, School of Medicine, Konkuk University, Chungju, South Korea; 9Department of Psychiatry, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, South Korea; 10Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, South Korea; 11Department of Psychiatry, Naju National Hospital, Naju, South Korea Objective: To constitute the third revision of the guidelines for the treatment of bipolar disorder issued by the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP 2014. Methods: A 56-item questionnaire was used to obtain the consensus of experts regarding pharmacological treatment strategies for the various phases of bipolar disorder and for special populations. The review committee included 110 Korean psychiatrists and 38 experts for child and adolescent psychiatry. Of the committee members, 64 general psychiatrists and 23 child and adolescent psychiatrists responded to the survey. Results: The treatment of choice (TOC for euphoric, mixed, and psychotic mania was the combination of a mood stabilizer (MS and an atypical antipsychotic (AAP; the TOC for

  5. Medical consequences and associations with untreated sleep-related breathing disorders and outcomes of treatments.

    Science.gov (United States)

    Norman, Daniel; Haberman, Paul B; Valladares, Edwin M

    2012-02-01

    Sleep-related breathing disorders are a broad group of disorders that include obstructive sleep apnea, central sleep apnea, and periodic breathing disorders. This article reviews the scientific literature that links SRBD to various medical conditions including hypertension, coronary artery disease, cardiac arrhythmias, stroke, diabetes mellitus, obesity, and depression. Pathophysiologic mechanisms by which SRBD may contribute to these disorders will be discussed, as will data on the degree to which treatment of SRBD may improve these conditions.

  6. Individual and hospital-specific factors influencing medical graduates' time to medical specialization.

    Science.gov (United States)

    Johannessen, Karl-Arne; Hagen, Terje P

    2013-11-01

    Previous studies of gender differences in relation to medical specialization have focused more on social variables than hospital-specific factors. In a multivariate analysis with extended Cox regression, we used register data for socio-demographic variables (gender, family and having a child born during the study period) together with hospital-specific variables (the amount of supervision available, efficiency pressure and the type of teaching hospital) to study the concurrent effect of these variables on specialty qualification among all 2474 Norwegian residents who began specialization in 1999-2001. We followed the residents until 2010. A lower proportion of women qualified for a specialty in the study period (67.9% compared with 78.7% of men, p specialization qualification (p specialization: working at university hospitals (regional) or central hospitals was associated with a reduction in the time taken to complete the specialization, whereas an increased patient load and less supervision had the opposite effect. Multivariate analysis showed that the smaller proportion of women who qualified for a specialty was explained principally by childbirth and by the number of children aged under 18 years. Copyright © 2013 Elsevier Ltd. All rights reserved.

  7. Current Medications for the Treatment of Attention-Deficit/Hyperactivity Disorder

    Science.gov (United States)

    Vaughan, Brigette S.; Roberts, Holly J.; Needelman, Howard

    2009-01-01

    Attention-Deficit/Hyperactivity Disorder (ADHD) is common among children. Fortunately, ADHD is highly treatable with medication. The purpose of this article is to serve as a primer on medication treatment for ADHD for school psychologists. The article discusses the available stimulant and nonstimulant medication for the treatment of ADHD.…

  8. Empathy in Children with Autism and Conduct Disorder: Group-Specific Profiles and Developmental Aspects

    Science.gov (United States)

    Schwenck, Christina; Mergenthaler, Julia; Keller, Katharina; Zech, Julie; Salehi, Sarah; Taurines, Regina; Romanos, Marcel; Schecklmann, Martin; Schneider, Wolfgang; Warnke, Andreas; Freitag, Christine M.

    2012-01-01

    Background: A deficit in empathy is discussed to underlie difficulties in social interaction of children with autism spectrum disorder (ASD) and conduct disorder (CD). To date, no study has compared children with ASD and different subtypes of CD to describe disorder-specific empathy profiles in clinical samples. Furthermore, little is known about…

  9. Assessment and importance of personality disorders in medical patients: an update.

    Science.gov (United States)

    Dhossche, D M; Shevitz, S A

    1999-06-01

    Personality disorders in medical patients have received less attention than depression, anxiety, or somatization. We conducted a selective literature search to assess the role of personality disorders in medical patients. Review of recent studies suggests a high prevalence and morbidity of personality disorders in medical populations. Important correlates in selected groups are depression, somatization, noncompliance, sexual risk taking, and substance abuse. Difficulties in physician-patient relationships are also frequently reported. Psychiatric interventions are considered beneficial, though no single treatment of choice is available. We recommend that physicians consider the possibility of personality disorders in medical patients to choose appropriate treatments for selected symptoms. Training in interviewing skills may enhance recognition of personality disorders and management of associated psychiatric conditions.

  10. Psychotropic Medication Use Among Adults With Schizophrenia and Schizoaffective Disorder in the United States.

    Science.gov (United States)

    Stroup, T Scott; Gerhard, Tobias; Crystal, Stephen; Huang, Cecilia; Tan, Zhiqiang; Wall, Melanie M; Mathai, Chacku M; Olfson, Mark

    2018-05-01

    The authors examined the use of different classes of psychotropic medication in outpatient treatment of schizophrenia and schizoaffective disorder. Data from the United States Medicaid program were used to examine psychotropic medication use in a cohort of patients who had a diagnosis of schizophrenia or schizoaffective disorder in the calendar year 2010. The cohort of Medicaid recipients who filled one or more prescriptions for a psychotropic medication in 2010 included 116,249 patients classified as having schizophrenia and 84,537 classified as having schizoaffective disorder. During 2010, 86.1% of patients with schizoaffective disorder and 70.1% with schizophrenia were treated with two or more different classes of psychotropic. Psychotropic medications other than antipsychotics were commonly prescribed for individuals with a diagnosis of schizophrenia or schizoaffective disorder. Their widespread use and uncertainty about their net benefits signal a need for research on their efficacy, safety, and appropriate use in these conditions.

  11. Specific comorbidity between bulimia nervosa and personality disorders.

    Science.gov (United States)

    Carroll, J M; Touyz, S W; Beumont, P J

    1996-03-01

    The present study investigates the comorbidity between bulimia nervosa (BN) and the entire range of American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, 3rd rev. ed. (DSM-III-R) personality disorders and controls for the presence of coexisting depression. The Personality Disorders Examination (PDE), a structured interview that encompasses all 13 (provisional) DSM-III-R personality disorders, was administered to three groups of subjects: depressed BN patients (n = 15), nondepressed BN patients (n = 15), and nonpsychiatric controls (n = 15). The BN patients were referrals to a dieting disorder unit affiliated with the University of Sydney. They all met DSM-III-R criteria and all had body mass indexes (BMIs) greater than 19. The nonpsychiatric control group were recruited from an undergraduate psychology course. All subjects were given the Bulimic Investigatory Test, Edinburgh (BITE), the Eating Disorders Inventory-2 (EDI-2), the Hamilton Depression Rating Scale (HDRS), and the PDE. 46.7% of depressed BN patients met the criteria for at least one Axis II diagnosis, as assessed by the PDE, and 33.3% of nondepressed BN patients received such a diagnosis, whereas only 6.7% of nonpsychiatric control subjects met this criterion (p personality disorders and BN that cannot be attributed to the confounding influence of coexisting depression. This finding enables the identification of subgroups of individuals with BN, enabling them to be compared and contrasted. The identification of differences between subgroups may provide information regarding prognosis and differential response to treatment, which could enable more appropriate treatment decisions to be made.

  12. Common mental disorders among medical students in Jimma University, SouthWest Ethiopia.

    Science.gov (United States)

    Kerebih, Habtamu; Ajaeb, Mohammed; Hailesilassie, Hailemariam

    2017-09-01

    Medical students are at risk of common mental disorders due to difficulties of adjustment to the medical school environment, exposure to death and human suffering. However there is limited data on this aspect. Therefore, the current study assessed the magnitude of common mental disorders and contributing factors among medical students. An institutional based cross-sectional study was conducted from May 12-16, 2015 using stratified sampling technique. Three hundred and five medical students participated in the study. Common mental disorders were assessed using the self-reported questionnaire (SRQ-20). Logistic regression analysis was used to identify factors associated with common mental disorders among students. Adjusted odds ratios with 95% confidence interval were computed to determine the level of significance. Prevalence of common mental disorders among medical students was 35.2%. Being female, younger age, married, having less than 250 birr monthly pocket money, attending pre-clinical class, khat chewing, smoking cigarettes, alcohol drinking and ganja/shisha use were significantly associated with common mental disorders. The overall prevalence of common mental disorders among medical students was high. Therefore, it is essential to institute effective intervention strategies giving emphasis to contributing factors to common mental disorders.

  13. Smaller superior temporal gyrus volume specificity in schizotypal personality disorder

    Science.gov (United States)

    Goldstein, Kim E.; Hazlett, Erin A.; New, Antonia S.; Haznedar, M. Mehmet; Newmark, Randall E.; Zelmanova, Yuliya; Passarelli, Vincent; Weinstein, Shauna R.; Canfield, Emily L.; Meyerson, David A.; Tang, Cheuk Y.; Buchsbaum, Monte S.; Siever, Larry J.

    2009-01-01

    Background Superior temporal gyrus (STG/BA22) volume is reduced in schizophrenia and to a milder degree in schizotypal personality disorder (SPD), representing a less severe disorder in the schizophrenia-spectrum. SPD and Borderline personality disorder (BPD) are severe personality disorders characterized by social and cognitive dysfunction. However, while SPD is characterized by social withdrawal/anhedonia, BPD is marked by hyper-reactivity to interpersonal stimuli and hyper-emotionality. This is the first morphometric study to directly compare SPD and BPD patients in temporal volume. Methods We compared three age-gender- and education-matched groups: 27 unmedicated SPD individuals with no BPD traits, 52 unmedicated BPD individuals with no SPD traits, and 45 healthy controls. We examined gray matter volume of frontal and temporal lobe Brodmann areas (BAs), and dorsal/ventral amygdala from 3T magnetic resonance imaging. Results In the STG, an auditory association area reported to be dysfunctional in SPD and BPD, the SPD patients had significantly smaller volume than healthy controls and BPD patients. No group differences were found between BPD patients and controls. Smaller BA22 volume was associated with greater symptom severity in SPD patients. Reduced STG volume may be an important endophenotype for schizophrenia-spectrum disorders. SPD is distinct from BPD in terms of STG volume abnormalities which may reflect different underlying pathophysiological mechanisms and could help discriminate between them. PMID:19473820

  14. Sentra PM (a Medical Food and Trazodone in the Management of Sleep Disorders

    Directory of Open Access Journals (Sweden)

    William E. Shell Md

    2012-04-01

    Full Text Available Sleep disorders are a common and poorly treated disease state. This double blind, four arm placebo-controlled, randomized trial compared (1 low dose trazodone, (2 Sentra PM, a neurotransmitter based medical food, (3 the joint administration of trazodone and the medical food Sentra PM and (4 placebo. There were 111 subjects studied in 12 independent sites. Subjects underwent baseline screening, informed consent and an initial sleep questionnaire. After 14 days subjects underwent a second evaluation by questionnaire. At baseline and Day 14 the subjects underwent 24 hour ECG recordings that were analyzed in the frequency domain of heart rate variability. The specific high frequency parasympathetic autonomic nervous system activity was analyzed. The primary endpoints were sleep latency and parasympathetic autonomic nervous system improvement in sleeping hours. The results showed improvement in sleep latency for the Sentra PM and combination of Sentra PM and trazodone (−41 and −56 minutes P < 0.001. There was an improvement in quality of sleep for the amino acid formulation Sentra PM and the combination (3.86 and 6.48 Likert units on a 10 point scale P < 0.001. There was an activation of circadian activity percent at night in the medical food and combination groups while there was no change in parasympathetic activity in either the placebo or trazodone group. These data indicate that Sentra PM can improve the quality of sleep, the response to trazodone as a sleep medication and parasympathetic autonomic nervous system activity.

  15. Association of depressive disorders, depression characteristics and antidepressant medication with inflammation.

    Science.gov (United States)

    Vogelzangs, N; Duivis, H E; Beekman, A T F; Kluft, C; Neuteboom, J; Hoogendijk, W; Smit, J H; de Jonge, P; Penninx, B W J H

    2012-02-21

    Growing evidence suggests that immune dysregulation may be involved in depressive disorders, but the exact nature of this association is still unknown and may be restricted to specific subgroups. This study examines the association between depressive disorders, depression characteristics and antidepressant medication with inflammation in a large cohort of controls and depressed persons, taking possible sex differences and important confounding factors into account. Persons (18-65 years) with a current (N = 1132) or remitted (N = 789) depressive disorder according to DSM-IV criteria and healthy controls (N = 494) were selected from the Netherlands Study of Depression and Anxiety. Assessments included clinical characteristics (severity, duration and age of onset), use of antidepressant medication and inflammatory markers (C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α)). After adjustment for sociodemographics, currently depressed men, but not women, had higher levels of CRP (1.33 versus 0.92 mg l(-1), Pdepressed peers. Associations reduced after considering lifestyle and disease indicators--especially body mass index--but remained significant for CRP. After full adjustment, highest inflammation levels were found in depressed men with an older age of depression onset (CRP, TNF-α). Furthermore, inflammation was increased in men using serotonin-norepinephrine reuptake inhibitors (CRP, IL-6) and in men and women using tri- or tetracyclic antidepressants (CRP), but decreased among men using selective serotonin reuptake inhibitors (IL-6). In conclusion, elevated inflammation was confirmed in depressed men, especially those with a late-onset depression. Specific antidepressants may differ in their effects on inflammation.

  16. Medical comorbidities in children and adolescents with autism spectrum disorders and attention deficit hyperactivity disorders: a systematic review.

    Science.gov (United States)

    Muskens, Jet B; Velders, Fleur P; Staal, Wouter G

    2017-09-01

    Somatic disorders occur more often in adult psychiatric patients than in the general adult population. However, in child and adolescent psychiatry this association is unclear, mainly due to a lack of integration of existing data. To address this issue, we here present a systematic review on medical comorbidity in the two major developmental disorders autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) and formulate clinical recommendations. The literature was searched using the PubMed and PsycINFO databases (2000-1 May 2016) with the keywords "[((child and adolescent) AND (Autism OR Attention Deficit Hyperactivity Disorder* OR ADHD)) AND ("Cardiovascular Diseases" [Mesh] OR "Endocrine System Diseases" [Mesh] OR "Immune System Diseases" [Mesh] OR "Neurobehavioral Manifestations" [Mesh] OR "Gastrointestinal Disorders" [Mesh] OR Somatic OR Autoimmune disease OR Nervous system disease OR Infection OR Infectious disease)]. Two raters independently assessed the quality of the eligible studies. The initial search identified 5278 articles. Based on inclusion and exclusion criteria 104 papers were selected and subsequently subjected to a quality control. This quality was assessed according to a standardized and validated set of criteria and yielded 29 studies for inclusion. This thorough literature search provides an overview of relevant articles on medical comorbidity in ADHD and/or ASD, and shows that medical disorders in these children and adolescents appear to be widespread. Those who work with children with ASD and/or ADHD should be well aware of this and actively promote routine medical assessment. Additionally, case-control studies and population-based studies are needed to provide reliable prevalence estimates. Future studies should furthermore focus on a broader evaluation of medical disorders in children and adolescents with ADHD and/or ASD to improve treatment algorithm in this vulnerable group.

  17. Specific developmental disorders. The language-learning continuum.

    Science.gov (United States)

    Swank, L K

    1999-01-01

    The goal of this article is to inform and educate those who work with children who present with language-learning disorders about phonologic processing deficits, because this area has been shown to have a significant impact on children and adults who exhibit reading disabilities. Mental health professionals who work with children with reading problems need to be aware of what is known about this source of reading disorders and the implications of this knowledge for prevention and treatment. Advocating for appropriate instruction for children with reading problems is an important role mental health professionals can play in working with this population.

  18. Increased use of antimicrobial medication in bulimia nervosa and binge-eating disorder prior to the eating disorder treatment.

    Science.gov (United States)

    Raevuori, Anu; Lukkariniemi, Laura; Suokas, Jaana T; Gissler, Mika; Suvisaari, Jaana M; Haukka, Jari

    2016-06-01

    We examined the use of antimicrobial medication as a proxy for infections in large patient cohort treated for binge-eating disorder (BED), bulimia nervosa (BN), and anorexia nervosa (AN) over the five-year period preceding eating disorder treatment. Patients (N = 1592) at the Eating Disorder Unit of Helsinki University Central Hospital between 2000 and 2010 were compared with matched general population controls (N = 6368). The study population was linked to the prescription data of antibacterial, antifungal and antiviral medication from the Register on Reimbursed Prescription Medicine. Data were analyzed using regression models. Individuals with BN and BED had received more often antimicrobial medication prescriptions compared to their controls (OR: 1.7, 95% CI: 1.3-2.1; OR: 2.6, 95% CI: 1.4-4.6, respectively), while no significant difference emerged in AN (OR: 0.9, 95% CI: 0.7-1.0, p = 0.10). Of the main drug categories, the respective pattern was seen in antibacterial and antifungal medication, while increased use for antivirals appeared only in BN (OR: 1.6, 95% CI: 1.1-2.3). Measured with the mean number of prescriptions or mean Defined Daily Doses per individual, patients with BN, BED and males with AN had also higher total antimicrobial medication use. Indicating increased infections, we found elevated use of antimicrobial medication in BN, BED and in males with AN. Infections may be consequence of hyperglycemia, weight gain, or dysregulation of intestinal microbiota associated with core eating disorder behaviors. Or the other way round; changes in intestinal microbiota due to infections, inflammation, or antibacterial medications might contribute to eating disorders in multiple ways. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:542-552). © 2016 Wiley Periodicals, Inc.

  19. Teasing out specific language impairment from an autism spectrum disorder.

    Science.gov (United States)

    Tierney, Cheryl D; Gupta, Vidya Bhushan; Angel, Alma Patricia Del; Augustyn, Marilyn

    2012-04-01

    Marcus is a handsome, sweet, 7½-year-old boy with a significant history of delayed development, specifically in speech and language skills, as well as difficulties with social interactions that have led other specialists to be concerned about a diagnosis of an autism spectrum disorder.He has been seen in our primary care practice since birth. He was born full-term after vaginal delivery weighing 6 pounds, 6 ounces. There were no pregnancy or delivery complications noted. Genetic testing revealed normal chromosomes, fragile X, and microarray testing. Marcus was a picky eater and good sleeper and had delays in toilet training.There is no family history of attention-deficit hyperactivity disorder (ADHD), autism, or substance abuse. Maternal grandmother and mother have a history of learning difficulties, and his father and a paternal uncle have a history of depression and anxiety. Marcus lives in a supportive environment with his mother, father, and sister.Marcus was noted to have significantly delayed language, stuttering, and immediate echolalia as a toddler. Gross and fine motor milestones were met on time, but he did not talk or follow directions until 4 to 5 years old. As a younger child, he would pretend to talk on the phone or mow the grass with a pretend lawn mower, but other household activities were not of interest to Marcus.Currently, he enjoys puzzles, reading, and board games. He likes to play with other children and can interact with familiar adults. Marcus is reported to initiate social interactions, although he has difficulty in understanding personal space. Imaginative play is preferred over other types. He seeks out adult attention and will bring objects over to an adult especially to share his perceived accomplishment. Marcus has difficulty in playing cooperatively with his sister.He is independent with activities of daily living. Marcus is noted to have auditory defensiveness including covering his ears to loud noises and becoming distressed

  20. Financial factors and the implementation of medications for treating opioid use disorders.

    Science.gov (United States)

    Knudsen, Hannah K; Roman, Paul M

    2012-12-01

    Despite the established effectiveness of pharmacotherapies for treating opioid use disorders, implementation of medications for addiction treatment (MAT) by specialty treatment programs is limited. This research examined relationships between organizational factors and the program-level implementation of MAT, with attention paid to specific sources of funding, organizational structure, and workforce resources. Face-to-face structured interviews were conducted in 2008 to 2009 with administrators of 154 community-based treatment programs affiliated with the National Institute on Drug Abuse's Clinical Trials Network; none of these programs exclusively dispensed methadone without offering other levels of care. Implementation of MAT was measured by summing the percentages of opioid patients receiving buprenorphine maintenance, methadone maintenance, and tablet naltrexone. Financial factors included the percentages of revenues received from Medicaid, private insurance, criminal justice, the Federal block grant, state government, and county government. Organizational structure and workforce characteristics were also measured. Implementation of MAT for opioid use disorders was low. Greater reliance on Medicaid was positively associated with implementation after controlling for organizational structure and workforce measures, whereas the association for reliance on criminal justice revenues was negative. The implementation of MAT for opioid use disorders by specialty addiction treatment programs may be facilitated by Medicaid but may be impeded by reliance on funding from the criminal justice system. These findings point to the need for additional research that considers the impact of organizational dependence on different types of funding on patterns of addiction treatment practice.

  1. Keep calm and carry on: Mental disorder is not more "organic" than any other medical condition.

    Science.gov (United States)

    Micoulaud-Franchi, J A; Quiles, C; Masson, M

    2017-10-01

    Psychiatry as a discipline should no longer be grounded in the dualistic opposition between organic and mental disorders. This non-dualistic position refusing the partition along functional versus organic lines is in line with Jean Delay, and with Robert Spitzer who wanted to include in the definition of mental disorder discussed by the DSM-III task force the statement that "mental disorders are a subset of medical disorders". However, it is interesting to note that Spitzer and colleagues ingeniously introduced the definition of "mental disorder" in the DSM-III in the following statement: "there is no satisfactory definition that specifies precise boundaries for the concept "mental disorder" (also true for such concepts as physical disorder and mental and physical health)". Indeed, as for "mental disorders", it is as difficult to define what they are as it is to define what constitutes a "physical disorder". The problem is not the words "mental" or "organic" but the word "disorder". In this line, Wakefield has proposed a useful "harmful dysfunction" analysis of mental disorder. They raise the issue of the dualistic opposition between organic and mental disorders, and situate the debate rather between the biological/physiological and the social. The paper provides a brief analysis of this shift on the question of what is a mental disorder, and demonstrates that a mental disorder is not more "organic" than any other medical condition. While establishing a dichotomy between organic and psychiatry is no longer intellectually tenable, the solution is not to reduce psychiatric and non-psychiatric disorders to the level of "organic disorders" but rather to continue to adopt both a critical and clinically pertinent approach to what constitutes a "disorder" in medicine. Copyright © 2017 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

  2. Specific requirements for public exposure in medical practice

    International Nuclear Information System (INIS)

    Fernandez Gomez, Isis Maria

    2012-01-01

    The cause of radiation sources, by exposure to the public, has excluded all those medical and occupational exposures and exposure to natural background radiation normal, in the area. The main sources of public exposure that have found are: practices, discharges or spills, food or merchandise contaminated, chronic exposure scenarios (radon, NORM), waste management (predisposal management, storage, disposal). Public exposure can occur in two forms. One has been by procedure: transport, storage, handling of sources, radioactive waste, radioactive patient. The second has been per incident: transportation accidents, loss of sources, spread of contamination, unchecked pollution. (author) [es

  3. Impacts of nurses’ circadian rhythm sleep disorders, fatigue, and depression on medication administration errors

    Directory of Open Access Journals (Sweden)

    Abdelbaset M. Saleh

    2014-01-01

    Conclusions: Medication administration errors, fatigue and depression were all significantly affected by circadian sleep disorders. An administration’s control of work flow to provide convenient sleep hours will help in improving sleep circadian rhythms and consequently minimize these problems.

  4. Spasmodic Dysphonia: a Laryngeal Control Disorder Specific to Speech

    Science.gov (United States)

    Ludlow, Christy L.

    2016-01-01

    Spasmodic dysphonia (SD) is a rare neurological disorder that emerges in middle age, is usually sporadic, and affects intrinsic laryngeal muscle control only during speech. Spasmodic bursts in particular laryngeal muscles disrupt voluntary control during vowel sounds in adductor SD and interfere with voice onset after voiceless consonants in abductor SD. Little is known about its origins; it is classified as a focal dystonia secondary to an unknown neurobiological mechanism that produces a chronic abnormality of laryngeal motor neuron regulation during speech. It develops primarily in females and does not interfere with breathing, crying, laughter, and shouting. Recent postmortem studies have implicated the accumulation of clusters in the parenchyma and perivascular regions with inflammatory changes in the brainstem in one to two cases. A few cases with single mutations in THAP1, a gene involved in transcription regulation, suggest that a weak genetic predisposition may contribute to mechanisms causing a nonprogressive abnormality in laryngeal motor neuron control for speech but not for vocal emotional expression. Research is needed to address the basic cellular and proteomic mechanisms that produce this disorder to provide intervention that could target the pathogenesis of the disorder rather than only providing temporary symptom relief. PMID:21248101

  5. Spasmodic dysphonia: a laryngeal control disorder specific to speech.

    Science.gov (United States)

    Ludlow, Christy L

    2011-01-19

    Spasmodic dysphonia (SD) is a rare neurological disorder that emerges in middle age, is usually sporadic, and affects intrinsic laryngeal muscle control only during speech. Spasmodic bursts in particular laryngeal muscles disrupt voluntary control during vowel sounds in adductor SD and interfere with voice onset after voiceless consonants in abductor SD. Little is known about its origins; it is classified as a focal dystonia secondary to an unknown neurobiological mechanism that produces a chronic abnormality of laryngeal motor neuron regulation during speech. It develops primarily in females and does not interfere with breathing, crying, laughter, and shouting. Recent postmortem studies have implicated the accumulation of clusters in the parenchyma and perivascular regions with inflammatory changes in the brainstem in one to two cases. A few cases with single mutations in THAP1, a gene involved in transcription regulation, suggest that a weak genetic predisposition may contribute to mechanisms causing a nonprogressive abnormality in laryngeal motor neuron control for speech but not for vocal emotional expression. Research is needed to address the basic cellular and proteomic mechanisms that produce this disorder to provide intervention that could target the pathogenesis of the disorder rather than only providing temporary symptom relief.

  6. Association between eating disorders and body image in athletes and non-athlete students in Qazvin University of Medical Sciences

    Directory of Open Access Journals (Sweden)

    M. Miri

    2016-06-01

    Full Text Available Background: Body image dissatisfaction and eating disorders are of common problems in adolescence and adulthood especially among athletes. Objective: The aim of this study was to determine the association of eating disorders and body image in athletes and non-athlete students in Qazvin University of Medical Sciences. Methods: This cross-sectional study was conducted on 226 athlete students and 350 non-athlete students of Qazvin University of Medical Sciences during 2013-2014. Students who followed a specific sport field and had participated in at least one sport event were considered as athlete students. All athlete students were entered the study by census method. Non-athlete students were selected among students who had not any exercise activity and by random sampling method. Data were collected through demographic questionnaire, Eating Attitudes Test (EAT-26, and Multidimensional Body-Self Relations Questionnaire (MBSRQ. Data were analyzed using T-test and Chi-square test. Results: Mean age was 21.92±3.19 years and mean body mass index (BMI was 22.24±3.18 kg/m2. The frequency of eating disorders was 11.5% among the athlete students and 11.2% among the non-athlete students. Anorexia nervosa was found to be more prevalent than bulimia nervosa in both groups. The students with normal BMI had better body image perception and less eating disorders symptoms than other students. The association of age, educational level, and gender with eating disorders and body image was not statistically significant. The association of eating disorders and body image was not statistically significant. Eating disorders were more prevalent in males than females but the difference was not statistically significant. Conclusion: With regards to the results, it seems that eating disorders and body image dissatisfaction are relatively prevalent among both athletes and non-athlete students and BMI is predictor of eating disorders.

  7. Addressing Medical Needs of Adolescents and Adults with Autism Spectrum Disorders in a Primary Care Setting

    Science.gov (United States)

    Saqr, Youssra; Braun, Erika; Porter, Kyle; Barnette, Debra; Hanks, Christopher

    2018-01-01

    Little has been reported about how to improve health care access and delivery for adolescents and adults with autism spectrum disorder. To understand the contributions to the health disparities in the autism spectrum disorder population, we conducted two independent research approaches to learn about current medical needs. A retrospective chart…

  8. Schizophrenia and comorbid cannabis use disorders: Brain structure, function and the effect of antipsychotic medications

    NARCIS (Netherlands)

    Machielsen, M.W.J.

    2014-01-01

    The overall aim of the studies described in this thesis was to increase our understanding of schizophrenia, co-morbid cannabis use disorders and the effects of different antipsychotic medications in patients with schizophrenia and a comorbid cannabis use disorder. Therefore we studied the clinical

  9. Shared and disorder-specific task-positive and default mode network dysfunctions during sustained attention in paediatric Attention-Deficit/Hyperactivity Disorder and obsessive/compulsive disorder

    Directory of Open Access Journals (Sweden)

    Luke J. Norman

    2017-01-01

    Full Text Available Patients with Attention-Deficit/Hyperactivity Disorder (ADHD and obsessive/compulsive disorder (OCD share problems with sustained attention, and are proposed to share deficits in switching between default mode and task positive networks. The aim of this study was to investigate shared and disorder-specific brain activation abnormalities during sustained attention in the two disorders. Twenty boys with ADHD, 20 boys with OCD and 20 age-matched healthy controls aged between 12 and 18 years completed a functional magnetic resonance imaging (fMRI version of a parametrically modulated sustained attention task with a progressively increasing sustained attention load. Performance and brain activation were compared between groups. Only ADHD patients were impaired in performance. Group by sustained attention load interaction effects showed that OCD patients had disorder-specific middle anterior cingulate underactivation relative to controls and ADHD patients, while ADHD patients showed disorder-specific underactivation in left dorsolateral prefrontal cortex/dorsal inferior frontal gyrus (IFG. ADHD and OCD patients shared left insula/ventral IFG underactivation and increased activation in posterior default mode network relative to controls, but had disorder-specific overactivation in anterior default mode regions, in dorsal anterior cingulate for ADHD and in anterior ventromedial prefrontal cortex for OCD. In sum, ADHD and OCD patients showed mostly disorder-specific patterns of brain abnormalities in both task positive salience/ventral attention networks with lateral frontal deficits in ADHD and middle ACC deficits in OCD, as well as in their deactivation patterns in medial frontal DMN regions. The findings suggest that attention performance in the two disorders is underpinned by disorder-specific activation patterns.

  10. Medication Related Cutaneous Disorders in End Stage Renal ...

    African Journals Online (AJOL)

    TNHJOURNALPH

    BACKGROUND. In End Stage Renal Disease (ESRD) patients, a wide range of cutaneous manifestations are present which may be due to the medications prescribed. Most patients' with ESRD are on numerous medications for their primary ailment, with transplant patients needing long term steroids and cytotoxics for ...

  11. Concurrent Medical and Psychiatric Disorders among Schizophrenic and Neurotic Outpatients.

    Science.gov (United States)

    Lima, Bruno R.; Pai, Shaila

    Although the occurrence of medical illnesses in psychiatric patients is quite high, medical illnesses manifested by psychiatric symptoms are often overlooked. The higher mortality rates among psychiatric patients when compared to the general population may be a reflection of neglect or inadequate treatment of the psychiatric patients' medical…

  12. Sexual Dysfunction 1 - Sexual sequelae of general medical disorders

    NARCIS (Netherlands)

    Basson, Rosemary; Schultz, Willibrord Weijmar

    2007-01-01

    That sexual symptoms can signal serious underlying disease confirms the importance of sexual enquiry as an integral component of medical assessment. Data on sexual function are sparse in some medical specialties. However, increased scientific understanding of the central and peripheral physiology of

  13. Use of attention-deficit/hyperactivity disorder medication among older adults in Denmark

    DEFF Research Database (Denmark)

    Ormhøj, Stina Schultz; Pottegård, Anton; Gasse, Christiane

    2018-01-01

    AIMS: Knowledge on the use of attention-deficit/hyperactivity disorder (ADHD) medication among older adults is limited. We hypothesized that ADHD medication is used off-label in adults aged ≥50 years as part of palliative care in e.g. cancer patients. The aim of this study was to describe the use...... of ADHD medication among adults aged ≥50 years in Denmark. METHODS: Using the Danish health registries, we identified new users ≥50 years of ADHD medication during 2000-2012. We estimated the annual incidence of ADHD medication use and ADHD diagnoses. We described new users of ADHD medication according...... to co-medication, comorbidities and assessed the 1-year cumulative mortality rate. A posthoc analysis allowed us to include new users until 2015. RESULTS: We identified 6690 new users of ADHD medication from 2000 to 2012. From 2000 to 2015 we observed an increase in the incidence of ADHD medication use...

  14. Role of childhood adversity in the development of medical co-morbidities associated with bipolar disorder

    NARCIS (Netherlands)

    Post, Robert M.; Altshuler, Lori L.; Leverich, Gabriele S.; Frye, Mark A.; Suppes, Trisha; McElroy, Susan L.; Keck, Paul E.; Nolen, Willem A.; Kupka, Ralph W.; Grunze, Heinz; Rowe, Mike

    Objective: A role for childhood adversity in the development of numerous medical conditions in adults has been described in the general population, but has not been examined in patients with bipolar disorder who have multiple medical comorbidities which contribute to their premature mortality.

  15. Stressor specificity of central neuroendocrine responses: implications for stress-related disorders.

    Science.gov (United States)

    Pacák, K; Palkovits, M

    2001-08-01

    Despite the fact that many research articles have been written about stress and stress-related diseases, no scientifically accepted definition of stress exists. Selye introduced and popularized stress as a medical and scientific idea. He did not deny the existence of stressor-specific response patterns; however, he emphasized that such responses did not constitute stress, only the shared nonspecific component. In this review we focus mainly on the similarities and differences between the neuroendocrine responses (especially the sympathoadrenal and the sympathoneuronal systems and the hypothalamo-pituitary-adrenocortical axis) among various stressors and a strategy for testing Selye's doctrine of nonspecificity. In our experiments, we used five different stressors: immobilization, hemorrhage, cold exposure, pain, or hypoglycemia. With the exception of immobilization stress, these stressors also differed in their intensities. Our results showed marked heterogeneity of neuroendocrine responses to various stressors and that each stressor has a neurochemical "signature." By examining changes of Fos immunoreactivity in various brain regions upon exposure to different stressors, we also attempted to map central stressor-specific neuroendocrine pathways. We believe the existence of stressor-specific pathways and circuits is a clear step forward in the study of the pathogenesis of stress-related disorders and their proper treatment. Finally, we define stress as a state of threatened homeostasis (physical or perceived treat to homeostasis). During stress, an adaptive compensatory specific response of the organism is activated to sustain homeostasis. The adaptive response reflects the activation of specific central circuits and is genetically and constitutionally programmed and constantly modulated by environmental factors.

  16. Genetic susceptibility for specific cancers. Medical liability of the clinician.

    Science.gov (United States)

    Severin, M J

    1999-12-01

    The use of genetic profiling techniques to detect individuals with an increased susceptibility to heritable cancers has provoked recent legal interest in the duties of the attending physician and in the rights of patients and their families. In the current study specific prima facie and recently litigated cases are presented and explored to delineate the issues facing physicians and to illustrate the prerogatives of patients who are caught up in a heritable cancer enigma. Various courts have attempted to answer questions involving lawsuits in which incidents of breast/ovarian carcinoma and colon carcinoma have provoked claims of negligence against health care providers. Health care workers involved in the care of these patients have specific duties to these individuals. It would appear that physicians are being forced to assume the additional duty of delving into a patient's family history of cancer through multiple generations. This duty is followed by a responsibility to provide detailed counseling to those patients in whom such activity impacts the diagnosis and management of familial cancer.

  17. Nature and Specificity of Gestural Disorder in Children with Developmental Coordination Disorder: A Multiple Case Study

    Directory of Open Access Journals (Sweden)

    Orianne Costini

    2017-07-01

    Full Text Available Aim: Praxis assessment in children with developmental coordination disorder (DCD is usually based on tests of adult apraxia, by comparing across types of gestures and input modalities. However, the cognitive models of adult praxis processing are rarely used in a comprehensive and critical interpretation. These models generally involve two systems: a conceptual system and a production system. Heterogeneity of deficits is consistently reported in DCD, involving other cognitive skills such as executive or visual-perceptual and visuospatial functions. Surprisingly, few researches examined the impact of these functions in gestural production. Our study aimed at discussing the nature and specificity of the gestural deficit in DCD using a multiple case study approach.Method: Tasks were selected and adapted from protocols proposed in adult apraxia, in order to enable a comprehensive assessment of gestures. This included conceptual tasks (knowledge about tool functions and actions; recognition of gestures, representational (transitive, intransitive, and non-representational gestures (imitation of meaningless postures. We realized an additional assessment of constructional abilities and other cognitive domains (executive functions, visual-perceptual and visuospatial functions. Data from 27 patients diagnosed with DCD were collected. Neuropsychological profiles were classified using an inferential clinical analysis based on the modified t-test, by comparison with 100 typically developing children divided into five age groups (from 7 to 13 years old.Results: Among the 27 DCD patients, we first classified profiles that are characterized by impairment in tasks assessing perceptual visual or visuospatial skills (n = 8. Patients with a weakness in executive functions (n = 6 were then identified, followed by those with an impaired performance in conceptual knowledge tasks (n = 4. Among the nine remaining patients, six could be classified as having a visual

  18. Associations of specific psychiatric disorders with isolated focal dystonia, and monogenic and idiopathic Parkinson's disease.

    Science.gov (United States)

    Steinlechner, Susanne; Hagenah, Johann; Rumpf, Hans-Jürgen; Meyer, Christian; John, Ulrich; Bäumer, Tobias; Brüggemann, Norbert; Kasten, Meike; Münchau, Alexander; Klein, Christine; Lencer, Rebekka

    2017-06-01

    Comorbidity of psychiatric disorders in patients with movement disorders is common. Often, psychiatric symptoms manifest before the onset of the movement disorder, thus not representing a mere reaction to its burden. How the disease mechanisms of psychiatric and movement disorders are related is still poorly understood. The aim of the present study was to compare prevalence rates of specific psychiatric disorders between different movement disorders including isolated focal dystonia (IFD, N = 91), monogenic Parkinson's disease (PD, N = 41), idiopathic PD (N = 45), and a sample from a Northern Germany general population (TACOS Study; N = 4075). Our results indicate an odds ratio (OR) of 2.6 [confidence interval (CI) 1.7-4.0] for general axis I disorders in IFD, an OR of 2.5 (CI 1.4-4.7) in monogenic PD, and an OR of 1.4 (CI 0.8-2.6) in idiopathic PD. More specifically, the monogenic PD group showed the highest ORs for affective disorders including depression (OR = 4.9), bipolar disorder (OR = 17.4), and hypomanic episodes (OR = 17.0), whereas IFD expressed the highest rates of anxiety disorders (OR = 3.3). Psychotic symptoms were only observed in the PD groups but not in IFD. Our findings underline the notion that psychiatric disorders are part of the phenotypic spectrum of movement disorders. Moreover, they suggest that IFD, monogenic PD, and idiopathic PD are associated with specific psychiatric disorders indicating disturbances in a different neural circuitry for sensorimotor control.

  19. Self-Esteem of 8-14-Year-Old Children with Psychiatric Disorders: Disorder- and Gender-Specific Effects.

    Science.gov (United States)

    Stadelmann, Stephanie; Grunewald, Madlen; Gibbels, Charlotte; Jaeger, Sonia; Matuschek, Tina; Weis, Steffi; Klein, Annette Maria; Hiemisch, Andreas; von Klitzing, Kai; Döhnert, Mirko

    2017-02-01

    In this study, we investigated the relation between global and domain-specific self-esteem and psychiatric disorders. A sample of 577 children aged 8-14 years was recruited via psychiatric hospitals and from the general population. Parents were given a diagnostic interview to assess children's psychiatric diagnoses (current/past). Parents and children completed questionnaires on child symptoms. Children completed a questionnaire on global and domain-specific self-esteem (scales: scholastic competence, social acceptance, athletic performance and physical appearance, global self-esteem). Self-esteem of children with current psychiatric disorders was lower than that of healthy controls (η p 2 between 0.01 and 0.08). Concerning scholastic competence, social acceptance and global self-esteem, children with past psychiatric disorders scored also lower than healthy controls. Different current psychiatric disorders showed specific but small effects on dimensions of self-esteem (β between -0.08 and 0.19). Moreover, we found a gender × group interaction, indicating that girls with depressive and adjustment disorders were specifically impaired in their global self-esteem and perception of their physical appearance. Findings might help clinicians to focus on particular domains of self-esteem during the diagnostic process and to define adequate treatment goals.

  20. The medical management of attention-deficit/hyperactivity disorder ...

    African Journals Online (AJOL)

    Adele

    medical management options, their advantages or disadvantages, their clinical application ..... (irritability, sadness) and the rebound effect, where children appear to be even worse in the ..... The latter fear has been put to rest.67,68 One recent ...

  1. Working Memory Functioning in Children with Learning Disorders and Specific Language Impairment

    Science.gov (United States)

    Schuchardt, Kirsten; Bockmann, Ann-Katrin; Bornemann, Galina; Maehler, Claudia

    2013-01-01

    Purpose: On the basis of Baddeley's working memory model (1986), we examined working memory functioning in children with learning disorders with and without specific language impairment (SLI). We pursued the question whether children with learning disorders exhibit similar working memory deficits as children with additional SLI. Method: In…

  2. Neighborhood-Specific and General Social Support: Which Buffers the Effect of Neighborhood Disorder on Depression?

    Science.gov (United States)

    Kim, Joongbaeck; Ross, Catherine E.

    2009-01-01

    Is neighborhood-specific social support the most effective type of social support for buffering the effect of neighborhood disorder on depression? Matching theory suggests that it is. The authors extend the research on neighborhood disorder and adult depression by showing that individuals who have higher levels of both general and…

  3. General, Specific and Unique Cognitive Factors Involved in Anxiety and Depressive Disorders

    NARCIS (Netherlands)

    Drost, J.; van der Does, A.; Antypa, N.; Zitman, F.G.; van Dyck, R.; Spinhoven, P.

    2012-01-01

    Comorbidity among anxiety and depressive disorders is the rule rather than the exception. The Integrative Hierarchical Model proposes that each of these disorders contains general (common to all), specific (common to some) and unique components. However, research into this model is limited and

  4. Autism Spectrum Disorder in the DSM-5: Diagnostic Sensitivity and Specificity in Early Childhood

    Science.gov (United States)

    Christiansz, Jessica A.; Gray, Kylie M.; Taffe, John; Tonge, Bruce J.

    2016-01-01

    Changes to the DSM-5 Autism Spectrum Disorder (ASD) criteria raised concerns among parents and practitioners that the criteria may exclude some children with Pervasive Developmental Disorder (PDD). Few studies have examined DSM-5 sensitivity and specificity in children less than 5 years of age. This study evaluated 185 children aged 20-55 months…

  5. Suicide Attempts among Individuals with Specific Learning Disorders: An Underrecognized Issue

    Science.gov (United States)

    Fuller-Thomson, Esme; Carroll, Samara Z.; Yang, Wook

    2018-01-01

    Several studies have linked specific learning disorders (SLDs) with suicidal ideation, but less is known about the disorders' association with suicide attempts. This gap in the literature is addressed via the 2012 nationally representative Canadian Community Health Survey (n = 21,744). The prevalence of lifetime suicide attempts among those with…

  6. 77 FR 7549 - Revised Medical Criteria for Evaluating Visual Disorders

    Science.gov (United States)

    2012-02-13

    ... disorder that may result in abnormalities that do not appear on a standard eye examination. We also intend..., 2006, we explained that while the National Research Council (NRC) 2002 report, Visual Impairments.... We would add the definition of the term mean deviation (or defect), abbreviated as MD, which we use...

  7. Ketogenic diets improve behaviors associated with autism spectrum disorder in a sex-specific manner in the EL mouse.

    Science.gov (United States)

    Ruskin, David N; Fortin, Jessica A; Bisnauth, Subrina N; Masino, Susan A

    2017-01-01

    The core symptoms of autism spectrum disorder are poorly treated with current medications. Symptoms of autism spectrum disorder are frequently comorbid with a diagnosis of epilepsy and vice versa. Medically-supervised ketogenic diets are remarkably effective nonpharmacological treatments for epilepsy, even in drug-refractory cases. There is accumulating evidence that supports the efficacy of ketogenic diets in treating the core symptoms of autism spectrum disorders in animal models as well as limited reports of benefits in patients. This study tests the behavioral effects of ketogenic diet feeding in the EL mouse, a model with behavioral characteristics of autism spectrum disorder and comorbid epilepsy. Male and female EL mice were fed control diet or one of two ketogenic diet formulas ad libitum starting at 5weeks of age. Beginning at 8weeks of age, diet protocols continued and performance of each group on tests of sociability and repetitive behavior was assessed. A ketogenic diet improved behavioral characteristics of autism spectrum disorder in a sex- and test-specific manner; ketogenic diet never worsened relevant behaviors. Ketogenic diet feeding improved multiple measures of sociability and reduced repetitive behavior in female mice, with limited effects in males. Additional experiments in female mice showed that a less strict, more clinically-relevant diet formula was equally effective in improving sociability and reducing repetitive behavior. Taken together these results add to the growing number of studies suggesting that ketogenic and related diets may provide significant relief from the core symptoms of autism spectrum disorder, and suggest that in some cases there may be increased efficacy in females. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  8. Attachment and social cognition in borderline personality disorder: Specificity in relation to antisocial and avoidant personality disorders.

    Science.gov (United States)

    Beeney, Joseph E; Stepp, Stephanie D; Hallquist, Michael N; Scott, Lori N; Wright, Aidan G C; Ellison, William D; Nolf, Kimberly A; Pilkonis, Paul A

    2015-07-01

    Theory and research point to the role of attachment difficulties in borderline personality disorder (BPD). Attachment insecurity is believed to lead to chronic problems in social relationships, attributable, in part, to impairments in social cognition, which comprise maladaptive mental representations of self, others, and self in relation to others. However, few studies have attempted to identify social-cognitive mechanisms that link attachment insecurity to BPD and to assess whether such mechanisms are specific to the disorder. For the present study, empirically derived indices of mentalization, self-other boundaries, and identity diffusion were tested as mediators between attachment style and personality disorder symptoms. In a cross-sectional structural equation model, mentalization and self-other boundaries mediated the relationship between attachment anxiety and BPD. Mentalization partially mediated the relationship between attachment anxiety and antisocial personality disorder (PD) symptoms, and self-other boundaries mediated the relationship between attachment anxiety. (c) 2015 APA, all rights reserved).

  9. Medication persistence in Turkish children and adolescents with attention-deficit/hyperactivity disorder.

    Science.gov (United States)

    Ayaz, Muhammed; Ayaz, Ayşe Burcu; Soylu, Nusret; Yüksel, Serhat

    2014-10-01

    The aim of this study was to investigate medication persistence in Turkish children and adolescents with attention-deficit/hyperactivity disorder (ADHD). The effects of sociodemographic characteristics, symptom severity of ADHD, comorbidity, and treatment-related factors influencing medication persistence in children diagnosed with ADHD were studied. Medication persistence over a continuous 12 month period was evaluated for 877 children and adolescents between 6 and 18 years of age, who were diagnosed with ADHD for the first time and started to receive medication. Medication persistence was determined according to whether or not taking the prescribed medication continued for 12 months after the initiation of treatment. Whereas the symptom severity of ADHD was assessed by using the Turgay Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV)-based Child and Adolescent Behaviour Disorders Screening and Rating Scale-Parents Form (T-DSM-IV-S), perceived medication efficacy after the first treatment was evaluated by the Clinical Global Impressions-Improvement Scale (CGI-I). In this study, medication persistence over a continuous 12 month period occurred at a rate of 30.2% (n=265) in the subjects studied. The hierarchical regression analysis conducted in this research revealed that younger age, higher hyperactivity/impulsivity symptom severity, use of long-acting methylphenidate, addition of another ADHD medication, addition of other psychotropic medications, absence of side effects, and perceived medication efficacy were associated with successful medication persistence over a continuous 12 month period. Understanding the factors that affect medication persistence in ADHD may improve treatment efficacy and symptom control, while minimizing future risks.

  10. One session treatment for specific phobias in children: Comorbid anxiety disorders and treatment outcome.

    Science.gov (United States)

    Ryan, Sarah M; Strege, Marlene V; Oar, Ella L; Ollendick, Thomas H

    2017-03-01

    One-Session Treatment (OST) for specific phobias has been shown to be effective in reducing phobia severity; however, the effect of different types of co-occurring anxiety disorders on OST outcomes is unknown. The present study examined (1) the effects of co-occurring generalized anxiety disorder (GAD), social anxiety disorder (SAD), or another non-targeted specific phobia (OSP) on the efficacy of OST for specific phobias, and (2) the effects of OST on these co-occurring disorders following treatment. Three groups of 18 youth (7-15 years) with a specific phobia and comorbid GAD, SAD, or OSP were matched on age, gender, and phobia type. Outcome measures included diagnostic status and severity, and clinician rated improvement. All groups demonstrated an improvement in their specific phobia following treatment. Treatment was equally effective regardless of co-occurring anxiety disorder. In addition, comorbid anxiety disorders improved following OST; however, this effect was not equal across groups. The SAD group showed poorer improvement in their comorbid disorder than the GAD group post-treatment. However, the SAD group continued to improve and this differential effect was not evident six-months following treatment. The current study sample was small, with insufficient power to detect small and medium effect sizes. Further, the sample only included a portion of individuals with primary GAD or SAD, which may have attenuated the findings. The current study demonstrated that co-occurring anxiety disorders did not interfere with phobia treatment. OST, despite targeting a single specific phobia type, significantly reduced comorbid symptomatology across multiple anxiety disorders. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. Cardiovascular considerations of attention deficit hyperactivity disorder medications: a report of the European Network on Hyperactivity Disorders work group, European Attention Deficit Hyperactivity Disorder Guidelines Group on attention deficit hyperactivity disorder drug safety meeting.

    Science.gov (United States)

    Hamilton, Robert M; Rosenthal, Eric; Hulpke-Wette, Martin; Graham, John G I; Sergeant, Joseph

    2012-02-01

    Regulatory decisions regarding attention deficit hyperactivity disorder drug licensing and labelling, along with recent statements from professional associations, raise questions of practice regarding the evaluation and treatment of patients with attention deficit hyperactivity disorder. To address these issues for the European community, the European Network for Hyperkinetic Disorders, through its European Attention Deficit Hyperactivity Disorder Guidelines Group, organised a meeting between attention deficit hyperactivity disorder specialists, paediatric cardiovascular specialists, and representatives of the major market authorisation holders for attention deficit hyperactivity disorder medications. This manuscript represents their consensus on cardiovascular aspects of attention deficit hyperactivity disorder medications. Although sudden death has been identified in multiple young individuals on attention deficit hyperactivity disorder medication causing regulatory concern, when analysed for exposure using currently available data, sudden death does not appear to exceed that of the general population. There is no current evidence to suggest an incremental benefit to electrocardiography assessment of the general attention deficit hyperactivity disorder patient. Congenital heart disease patients have an increased prevalence of attention deficit hyperactivity disorder, and can benefit from attention deficit hyperactivity disorder therapies, including medication. The attention deficit hyperactivity disorder specialist is the appropriate individual to evaluate benefit and risk and recommend therapy in all patients, although discussion with a heart specialist is reasonable for congenital heart disease patients. For attention deficit hyperactivity disorder patients with suspected heart disease or risk factor/s for sudden death, assessment by a heart specialist is recommended, as would also be the case for a non-attention deficit hyperactivity disorder patient. The

  12. Metacognitive therapy versus disorder-specific CBT for comorbid anxiety disorders: A randomized controlled trial.

    Science.gov (United States)

    Johnson, Sverre Urnes; Hoffart, Asle; Nordahl, Hans M; Wampold, Bruce E

    2017-08-01

    Few studies have compared the effects of Metacognitive therapy (MCT) and Cognitive behavioral therapy (CBT) for comorbid anxiety disorders. In the current study we compared CBT and MCT for heterogeneous anxiety disorders in a residential setting. Ninety patients with a primary diagnosis of Post Traumatic Stress Disorder, Social Phobia or Panic disorder, with and without Agoraphobia, were randomized to either CBT or MCT. Patients were assessed at pre-treatment, post-treatment and one-year follow-up. Primary outcome measures were Beck Anxiety Inventory and ADIS IV and secondary outcome measures were SCID II, Beck Depression Inventory, Penn State Worry Questionnaire, The Symptom Checklist-90 and the Inventory of Interpersonal Problems-64. Treatment fidelity was satisfactory and therapist credibility was equal in both treatments. There was a significant difference in the level of anxiety favouring MCT at post-treatment (d=0.7), but there were no differences at one-year follow-up, mainly due to a further improvement in the CBT group during the follow-up period. Both treatments were efficacious. No differences in effect on comorbid diagnoses and symptoms were found, but MCT produced larger change in personality problems. MCT seems to have a more rapid effect on anxiety symptoms, but there were no significant differences in the long term for patients with comorbid anxiety disorders. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  13. Do current national and international guidelines have specific recommendations for older adults with bipolar disorder? A brief report.

    Science.gov (United States)

    Dols, Annemiek; Kessing, Lars Vedel; Strejilevich, Sergio A; Rej, Soham; Tsai, Shang-Ying; Gildengers, Ariel G; Almeida, Osvaldo P; Shulman, Kenneth I; Sajatovic, Martha

    2016-12-01

    Older adults with bipolar disorder (OABD) are a growing segment of patients with bipolar disorder (BD) for which specific guidelines are warranted. Although, OABD are frequently excluded from randomized controlled trials due to their age or somatic comorbidity, more treatment data from a variety of sources have become available in recent years. It is expected that at least some of this emerging information on OABD would be incorporated into treatment guidelines available to clinicians around the world. The International Society of Bipolar Disorders OABD task force compiled and compared recommendations from current national and international guidelines that specifically address geriatric or older individuals with BD (from year 2005 onwards). There were 34 guidelines, representing six continents and 19 countries. The majority of guidelines had no separate section on OABD. General principles for treating OABD with medication are recommended to be similar to those for younger adults, with special caution for side effects due to somatic comorbidity and concomitant medications. Therapeutic lithium serum levels are suggested to be lower but recommendations are very general and mostly not informed by specific research evidence. There is a lack of emphasis of OABD-specific issues in existing guidelines. Given the substantial clinical heterogeneity in BD across the life span, along with the rapidly expanding population of older individuals worldwide, and limited mental health workforce with geriatric expertise, it is critical that additional effort and resources be devoted to studying treatment interventions specific to OABD and that treatment guidelines reflect research findings. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  14. Eating disorders in medical students of Karachi, Pakistan-a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Memon Akhtar

    2012-02-01

    Full Text Available Abstract Background To assess the incidence of high-risk population of medical students with eating disorders in Karachi by using validated self-administered questionnaires. The earlier these disorders are diagnosed and assessed, the better the chances are for enhanced treatment and fuller recovery. Therefore, we intended to undertake a study to find out the frequency of such disorders among medical students of Karachi and design strategies to overcome them. Findings A descriptive cross sectional study was conducted in 435 medical students of Karachi. Data was collected using 2 self administered questionnaires, the SCOFF Eating Disorders Questionnaire and the Eating Attitudes Test (EAT-26. Subjects' body mass indexes (BMI were also calculated. The data was sorted and analyzed in SPSS version 16. According to EAT-26, 22.75% individuals were found to be at high-risk of eating disorders, with 87.9% females and 12.1% males. However, according to SCOFF questionnaire, 17% individuals were found to be at high-risk, with 78.4% females and 21.6% males. According to BMI calculation, 9% were severely underweight, 41.4% underweight, 41.1% normal, 7.6% overweight and 0.9% belonged to obese class 1. Conclusions A significant fraction of medical students in Karachi are at high risk of development of eating disorders, females being more prone than males. Strategies should be designed to prevent occurrence of such disorders among medical students that would undoubtedly hamper the availability of dependable medical services in future.

  15. The effect of social networks and social support on common mental disorders following specific life events.

    Science.gov (United States)

    Maulik, P K; Eaton, W W; Bradshaw, C P

    2010-08-01

    This study examined the association between life events and common mental disorders while accounting for social networks and social supports. Participants included 1920 adults in the Baltimore Epidemiologic Catchment Area Cohort who were interviewed in 1993-1996, of whom 1071 were re-interviewed in 2004-2005. Generalized estimating equations were used to analyze the data. Social support from friends, spouse or relatives was associated with significantly reduced odds of panic disorder and psychological distress, after experiencing specific life events. Social networks or social support had no significant stress-buffering effect. Social networks and social support had almost no direct or buffering effect on major depressive disorder, and no effect on generalized anxiety disorder and alcohol abuse or dependence disorder. The significant association between social support and psychological distress, rather than diagnosable mental disorders, highlights the importance of social support, especially when the severity of a mental health related problem is low.

  16. Anxiety Disorders

    Science.gov (United States)

    ... Registry Residents & Medical Students Residents Medical Students Patients & Families Mental Health Disorders/Substance Use Find a Psychiatrist Addiction and Substance Use Disorders ADHD Anxiety Disorders Autism Spectrum Disorder Bipolar Disorders Depression Eating Disorders Obsessive-Compulsive ...

  17. Effectiveness of Memantine in Improvement of Cognitive Deficits in Specific Learning Disorder

    Directory of Open Access Journals (Sweden)

    Elham Ahmadi Zahrani

    2016-12-01

    Full Text Available Abstract Background: Specific learning disorder is a neurodevelopmental disorder characterized by persistent difficulties in learning academic skills in reading, written expression, or mathematics. This study was performed to investigate the effectiveness of memantine in the relief of cognitive deficits (selective attention, sustained attention, and working memory in specific learning disorder. Materials and Methods: This study is a clinical trial. Of all children 8-12 years referred to Amir Kabir Hospital 94 patients diagnosed with specific learning disorder based on DSMV diagnostic interview referred by specialist and randomly divided by two groups, memantine and placebo. Cognitive deficits before and after treatment were measured with continuous performance test, Stroop test and Wechsler Digit Span forward and reverse and Corsi test. Results: Multivariate analysis of variance showed a significant difference in error when answering, omission answer and corrected answer in continuous performance test, but this difference is not significant in response time. Difference in forward, reverse and collected auditory was significant and not significant in the auditory span. In active visual working memory at corsi cube test, difference was significant (p <0.05. Conclusion: The results showed that memantine in improvement of sustained attention, auditory working memory and visual working memory, is effective, while in selective attention is not effective and according to similarities of learning disorder and Attention deficit / Hyperactivity disorder (ADHD and the effectiveness of memantine in improvement of symptoms of ADHD, we can also use this drug in improvement of cognitive deficits of specific learning disorder.

  18. 78 FR 69324 - Revised Medical Criteria for Evaluating Hematological Disorders

    Science.gov (United States)

    2013-11-19

    ...://www.regulations.gov , or in person, during regular business hours, by arranging with the contact... rehospitalizations for sickle cell disease, Journal of the American Medical Association, Apr;303(13), 1288-1294 (2010... radiographic review of hemophilic shoulder arthropathy, Clinical Orthopaedics and Related Research, Jun;423...

  19. A Medical Cloud-Based Platform for Respiration Rate Measurement and Hierarchical Classification of Breath Disorders

    Directory of Open Access Journals (Sweden)

    Atena Roshan Fekr

    2014-06-01

    Full Text Available The measurement of human respiratory signals is crucial in cyberbiological systems. A disordered breathing pattern can be the first symptom of different physiological, mechanical, or psychological dysfunctions. Therefore, a real-time monitoring of the respiration patterns, as well as respiration rate is a critical need in medical applications. There are several methods for respiration rate measurement. However, despite their accuracy, these methods are expensive and could not be integrated in a body sensor network. In this work, we present a real-time cloud-based platform for both monitoring the respiration rate and breath pattern classification, remotely. The proposed system is designed particularly for patients with breathing problems (e.g., respiratory complications after surgery or sleep disorders. Our system includes calibrated accelerometer sensor, Bluetooth Low Energy (BLE and cloud-computing model. We also suggest a procedure to improve the accuracy of respiration rate for patients at rest positions. The overall error in the respiration rate calculation is obtained 0.53% considering SPR-BTA spirometer as the reference. Five types of respiration disorders, Bradapnea, Tachypnea, Cheyn-stokes, Kaussmal, and Biot’s breathing are classified based on hierarchical Support Vector Machine (SVM with seven different features. We have evaluated the performance of the proposed classification while it is individualized to every subject (case 1 as well as considering all subjects (case 2. Since the selection of kernel function is a key factor to decide SVM’s performance, in this paper three different kernel functions are evaluated. The experiments are conducted with 11 subjects and the average accuracy of 94.52% for case 1 and the accuracy of 81.29% for case 2 are achieved based on Radial Basis Function (RBF. Finally, a performance evaluation has been done for normal and impaired subjects considering sensitivity, specificity and G-mean parameters

  20. Use of asthma medication during pregnancy and risk of specific congenital anomalies

    DEFF Research Database (Denmark)

    Garne, Ester; Hansen, Anne Vinkel; Morris, Joan

    2015-01-01

    BACKGROUND: Pregnant women with asthma need to take medication during pregnancy. OBJECTIVE: We sought to identify whether there is an increased risk of specific congenital anomalies after exposure to antiasthma medication in the first trimester of pregnancy. METHODS: We performed a population-bas...

  1. Mobile technology for medication adherence in people with mood disorders: A systematic review.

    Science.gov (United States)

    Rootes-Murdy, Kelly; Glazer, Kara L; Van Wert, Michael J; Mondimore, Francis M; Zandi, Peter P

    2018-02-01

    Medication non-adherence is a critical challenge for many patients diagnosed with mood disorders (Goodwin and Jamison, 1990). There is a need for alternative strategies that improve adherence among patients with mood disorders that are cost-effective, able to reach large patient populations, easy to implement, and that allow for communication with patients outside of in-person visits. Technology-based approaches to promote medication adherence are increasingly being explored to address this need. The aim of this paper is to provide a systematic review of the use of mobile technologies to improve medication adherence in patients with mood disorders. A total of nine articles were identified as describing mobile technology targeting medication adherence in mood disorder populations. Results showed overall satisfaction and feasibility of mobile technology, and reduction in mood symptoms; however, few examined effectiveness of mobile technology improving medication adherence through randomized control trials. Given the limited number of studies, further research is needed to determine long term effectiveness. Mobile technologies has the potential to improve medication adherence and can be further utilized for symptom tracking, side effects tracking, direct links to prescription refills, and provide patients with greater ownership over their treatment progress. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. The mixed message behind "Medication-Assisted Treatment" for substance use disorder.

    Science.gov (United States)

    Robinson, Sean M; Adinoff, Bryon

    2018-01-01

    The gap between treatment utilization and treatment need for substance use disorders (SUDs) remains a significant concern in our field. While the growing call to bridge this gap often takes the form of more treatment services and/or better integration of existing services, this perspective proposes that more effective labels for and transparent descriptions of existing services would also have a meaningful impact. Adopting the perspective of a consumer-based health-care model (wherein treatments and services are products and patients are consumers) allows us to consider how labels like Addiction-focused Medical Management, Medication-Assisted Treatment, Medication-Assisted Therapy, and others may actually be contributing to the underutilization problem rather than alleviating it. In this perspective, "Medication-Assisted Therapy" for opioid-use disorder (OUD) is singled out and discussed as inherently confusing, providing the message that pharmacotherapy for this disorder is a secondary treatment to other services which are generally regarded, in practice, as ancillary. That this mixed message is occurring amidst a nationwide "opioid epidemic" is a potential cause for concern and may actually serve to reinforce the longstanding, documented stigma against OUD pharmacotherapy. We recommend that referring to pharmacotherapy for SUD as simply "medication," as we do for other chronic medical disorders, will bring both clarity and precision to this effective treatment approach.

  3. The effect of medical treatment of attention deficit hyperactivity disorder (ADHD) on foster care caseloads

    DEFF Research Database (Denmark)

    Fallesen, Peter; Wildeman, Christopher

    2015-01-01

    = 157,938) in the period from 1998 to 2010 to show that increasing medical treatment of attention deficit hyperactivity disorder (ADHD) accounts for a substantial share of the decrease in foster care caseloads. According to our estimates, the decline in foster care caseloads during this period would...... have been 45% smaller absent increases in medical treatment of ADHD. These findings are especially provocative in light of recent research showing ambiguous effects of medical treatment of ADHD. Future research should be attentive to how medical treatment aimed at addressing children’s acute behavioral...

  4. Residents' and Fellows' Knowledge and Attitudes About Eating Disorders at an Academic Medical Center.

    Science.gov (United States)

    Anderson, Kristen; Accurso, Erin C; Kinasz, Kathryn R; Le Grange, Daniel

    2017-06-01

    This study examined physician residents' and fellows' knowledge of eating disorders and their attitudes toward patients with eating disorders. Eighty physicians across disciplines completed a survey. The response rate for this survey across disciplines was 64.5 %. Participants demonstrated limited knowledge of eating disorders and reported minimal comfort levels treating patients with eating disorders. Psychiatry discipline (p = 0.002), eating disorder experience (p = 0.010), and having ≥4 eating disorder-continuing medical education credits (p = 0.037) predicted better knowledge of anorexia nervosa but not bulimia nervosa. Psychiatry residents (p = 0.041), and those who had treated at least one eating disorder patient (p = 0.006), reported significantly greater comfort treating patients with eating disorders. These results suggest that residents and fellows from this sample may benefit from training to increase awareness and confidence necessary to treat patients with eating disorders. Sufficient knowledge and comfort are critical since physicians are often the first health care provider to have contact with patients who have undiagnosed eating disorders.

  5. Brazilian Medical Association guidelines for the diagnosis and differential diagnosis of panic disorder

    Directory of Open Access Journals (Sweden)

    Michelle Nigri Levitan

    2013-12-01

    Full Text Available Objective: To present the most relevant findings regarding the Brazilian Medical Association guidelines for the diagnosis and differential diagnosis of panic disorder. Methods: We used the methodology proposed by the Brazilian Medical Association for the Diretrizes Project. The MEDLINE (PubMed, Scopus, Web of Science, and LILACS online databases were queried for articles published from 1980 to 2012. Searchable questions were structured using the PICO format (acronym for “patient” [or population], “intervention” [or exposure], “comparison” [or control], and “outcome”. Results: We present data on clinical manifestations and implications of panic disorder and its association with depression, drug abuse, dependence and anxiety disorders. In addition, discussions were held on the main psychiatric and clinical differential diagnoses. Conclusions: The guidelines are proposed to serve as a reference for the general practitioner and specialist to assist in and facilitate the diagnosis of panic disorder.

  6. Acute kidney injury in pregnancy-specific disorders

    Directory of Open Access Journals (Sweden)

    J Prakash

    2017-01-01

    Full Text Available The incidence of acute kidney injury in pregnancy (P-AKI has declined significantly over the last three decades in developing countries. However, it is still associated with significant fetomaternal mortality and morbidity. The diagnosis of P-AKI is based on the serum creatinine increase. The usual formulas for estimating glomerular filtration rate (GFR are not validated in this population. The incidence of P-AKI with respect to total AKI cases has decreased in the last three decades from 25% in 1980s to 9% in 2000s at our centre. During the first trimester of gestation, AKI develops most often due to septic abortion or hyperemesis gravidarum. Septic abortion related AKI with respect to total AKI decreased from 9% to 5% in our study. Prevention of unwanted pregnancy and avoidance of septic abortion are keys to eliminate abortion associated AKI in early pregnancy. However, we have not seen AKI on account of hyperemesis gravidarum over a period of 33 years at our center. In the third trimester, the differential diagnosis of AKI in association with pregnancy specific conditions namely preeclampsia/HELLP syndrome, acute fatty liver of pregnancy and thrombotic microangiopathies of pregnancy (P-TMA is more challenging, because these 3 conditions share several clinical features of thrombotic microangiopathy which makes the diagnosis very difficult on clinical grounds. It is imperative to distinguish these conditions to make appropriate therapeutic decisions. Typically, AFLP and HELLP syndrome improve after delivery of the fetus, whereas plasma exchange is the first-line treatment for pregnancy associated thrombotic microangioathies (P-TMA. We observed that preclampsia/eclampsia is the most common cause of AKI in late third trimester and postpartum periods followed by puerperal sepsis and postpartum hemorrhage. Pregnancy-associated thrombotic microangiopathies (aHUS/TTP and AFLP are rare causes of AKI during pregnancy in developing countries.

  7. Acute Kidney Injury in Pregnancy-specific Disorders.

    Science.gov (United States)

    Prakash, J; Ganiger, V C

    2017-01-01

    The incidence of acute kidney injury in pregnancy (P-AKI) has declined significantly over the last three decades in developing countries. However, it is still associated with significant fetomaternal mortality and morbidity. The diagnosis of P-AKI is based on the serum creatinine increase. The usual formulas for estimating glomerular filtration rate (GFR) are not validated in this population. The incidence of P-AKI with respect to total AKI cases has decreased in the last three decades from 25% in 1980s to 9% in 2000s at our centre. During the first trimester of gestation, AKI develops most often due to septic abortion or hyperemesis gravidarum. Septic abortion related AKI with respect to total AKI decreased from 9% to 5% in our study. Prevention of unwanted pregnancy and avoidance of septic abortion are keys to eliminate abortion associated AKI in early pregnancy. However, we have not seen AKI on account of hyperemesis gravidarum over a period of 33 years at our center. In the third trimester, the differential diagnosis of AKI in association with pregnancy specific conditions namely preeclampsia/HELLP syndrome, acute fatty liver of pregnancy and thrombotic microangiopathies of pregnancy (P-TMA) is more challenging, because these 3 conditions share several clinical features of thrombotic microangiopathy which makes the diagnosis very difficult on clinical grounds. It is imperative to distinguish these conditions to make appropriate therapeutic decisions. Typically, AFLP and HELLP syndrome improve after delivery of the fetus, whereas plasma exchange is the first-line treatment for pregnancy associated thrombotic microangioathies (P-TMA). We observed that preclampsia/eclampsia is the most common cause of AKI in late third trimester and postpartum periods followed by puerperal sepsis and postpartum hemorrhage. Pregnancy-associated thrombotic microangiopathies (aHUS/TTP) and AFLP are rare causes of AKI during pregnancy in developing countries.

  8. Maternal anxiety versus depressive disorders: specific relations to infants' crying, feeding and sleeping problems.

    Science.gov (United States)

    Petzoldt, J; Wittchen, H-U; Einsle, F; Martini, J

    2016-03-01

    Maternal depression has been associated with excessive infant crying, feeding and sleeping problems, but the specificity of maternal depression, as compared with maternal anxiety remains unclear and manifest disorders prior to pregnancy have been widely neglected. In this prospective longitudinal study, the specific associations of maternal anxiety and depressive disorders prior to, during and after pregnancy and infants' crying, feeding and sleeping problems were investigated in the context of maternal parity. In the Maternal Anxiety in Relation to Infant Development (MARI) Study, n = 306 primiparous and multiparous women were repeatedly interviewed from early pregnancy until 16 months post partum with the Composite International Diagnostic Interview for Women (CIDI-V) to assess DSM-IV anxiety and depressive disorders. Information on excessive infant crying, feeding and sleeping problems was obtained from n = 286 mothers during postpartum period via questionnaire and interview (Baby-DIPS). Findings from this study revealed syndrome-specific risk constellations for maternal anxiety and depressive disorders as early as prior to pregnancy: Excessive infant crying (10.1%) was specifically associated with maternal anxiety disorders, especially in infants of younger and lower educated first-time mothers. Feeding problems (36.4%) were predicted by maternal anxiety (and comorbid depressive) disorders in primiparous mothers and infants with lower birth weight. Infant sleeping problems (12.2%) were related to maternal depressive (and comorbid anxiety) disorders irrespective of maternal parity. Primiparous mothers with anxiety disorders may be more prone to anxious misinterpretations of crying and feeding situations leading to an escalation of mother-infant interactions. The relation between maternal depressive and infant sleeping problems may be better explained by a transmission of unsettled maternal sleep to the fetus during pregnancy or a lack of daily

  9. 'No man is an island'. Testing the specific role of social isolation in formal thought disorder.

    Science.gov (United States)

    de Sousa, Paulo; Spray, Amy; Sellwood, William; Bentall, Richard P

    2015-12-15

    Recent work has focused on the role of the environment in psychosis with emerging evidence that specific psychotic experiences are associated with specific types of adversity. One risk factor that has been often associated with psychosis is social isolation, with studies identifying isolation as an important feature of prodromal psychosis and others reporting that social networks of psychotic patients are smaller and less dense than those of healthy individuals. In the present study, we tested a prediction that social isolation would be specifically associated with formal thought disorder. 80 patients diagnosed with psychosis-spectrum disorder and 30 healthy participants were assessed for formal thought disorder with speech samples acquired during an interview that promoted personal disclosure and an interview targeting everyday topics. Social isolation was significantly associated with formal thought disorder in the neutral interview and in the salient interview, even when controlling for comorbid hallucinations, delusions and suspiciousness. Hallucinations, delusions and suspiciousness were not associated with social isolation when formal thought disorder was controlled for. Formal thought disorder is robustly and specifically associated with social isolation. Social cognitive mechanisms and processes are discussed which may explain this relationship as well as implications for clinical practice and future research. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  10. Previous medical history of diseases in children with attention deficit hyperactivity disorder and their parents

    Directory of Open Access Journals (Sweden)

    Ayyoub Malek

    2014-02-01

    Full Text Available Introduction: The etiology of Attention deficit hyperactivity disorder (ADHD is complex and most likely includes genetic and environmental factors. This study was conducted to evaluatethe role of previous medical history of diseases in ADHD children and their parents during theearlier years of the ADHD children's lives. Methods: In this case-control study, 164 ADHD children attending to Child and AdolescentPsychiatric Clinics of Tabriz University of Medical Sciences, Iran, compared with 166 normal children selected in a random-cluster method from primary and guidance schools. ADHDrating scale (Parents version and clinical interview based on schedule for Schedule forAffective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version(K-SADS were used to diagnose ADHD cases and to select the control group. Two groupswere compared for the existence of previous medical history of diseases in children andparents. Fisher's exact test and logistic regression model were used for data analysis. Results: The frequency of maternal history of medical disorders (28.7% vs. 12.0%; P = 0.001was significantly higher in children with ADHD compared with the control group. The frequency of jaundice, dysentery, epilepsy, asthma, allergy, and head trauma in the medicalhistory of children were not significantly differed between the two groups. Conclusion: According to this preliminary study, it may be concluded that the maternal historyof medical disorders is one of contributing risk factors for ADHD.

  11. The Presentation of Body Dysmorphic Disorder in Medical Settings

    Science.gov (United States)

    Phillips, Katharine A.

    2006-01-01

    Body dysmorphic disorder (BDD) is a relatively common psychiatric illness that often presents to mental health professionals as well as nonpsychiatric physicians. However, BDD usually goes unrecognized and undiagnosed in clinical settings. It is important to recognize and accurately diagnose BDD because this often secret illness may be debilitating. Patients with BDD typically have markedly impaired functioning, notably poor quality of life, and a high rate of suicidal ideation and suicide attempts. Thus, it is important to screen patients for BDD and avoid misdiagnosing it as another illness. Nonpsychiatric treatments (eg, dermatologic, surgical), which most patients seek and receive, appear ineffective for BDD and can be risky for physicians to provide. This article provides a clinically focused overview of BDD, including its symptoms, morbidity, case examples, nonpsychiatric (ie, cosmetic) treatment, diagnostic “do’s” and “don’ts,” and suggestions for how to persuade patients to accept appropriate psychiatric care. PMID:17183412

  12. Differences in behavioral health disorders and unmet treatment needs between medical marijuana users and recreational marijuana users: Results from a national adult sample.

    Science.gov (United States)

    Park, Ji-Yeun; Wu, Li-Tzy

    2017-11-01

    Available data suggest that medical marijuana users may have more mental health problems than recreational marijuana users. There is limited information about differences in behavioral health disorders and unmet treatment needs between medical and recreational marijuana users. We compared past-year prevalence of behavioral health disorders and unmet treatment needs across three marijuana subgroups (recreational use only, medical use only, and both). Sex-stratified logistic regression was performed to determine their associations with marijuana use status. We analyzed data from adults (≥18 years) who used marijuana in the past year (N=15,440) from 2013 to 2014 National Surveys on Drug Use and Health. Among 15,440 past-year marijuana users, 90.2% used recreational marijuana only, 6.2% used medical marijuana only, and 3.6% used both. Both users had the highest prevalence of behavioral health disorders and unmet treatment needs overall, with no significant sex differences. In the sex-specific logistic regression analysis, medical only users and both users showed somewhat different patterns of associations (reference group=recreational only users). Medical only users had decreased odds of alcohol or drug use disorders, and unmet need for alcohol or drug treatment among males and females. Additionally, female medical only users had decreased odds of opioid use disorder. Both users had increased odds of major depressive episode, hallucinogen use disorder, and unmet need for mental health services among males, and cocaine use disorder among females. Different approaches tailored to individuals' sex and motives for marijuana use is needed for the prevention and treatment of behavioral health problems. Copyright © 2017 Elsevier B.V. All rights reserved.

  13. Child attention deficit hyperactive disorder co morbidities on family stress: effect of medication.

    Science.gov (United States)

    Silva, Desiree; Houghton, Stephen; Hagemann, Erika; Jacoby, Peter; Jongeling, Brad; Bower, Carol

    2015-04-01

    We examined the degree of parental and child mental health in a community sample of children diagnosed with Attention Deficit Hyperactive Disorder and the effect on family stress prior to and during treatment using a community retrospective questionnaire study. In total 358 questionnaires were returned for analysis where 92 % of children had at least one co-morbid condition and mental health conditions in parents was common. Overall, the Family Strain Index was significantly reduced after commencement of medication (p disorders or autism spectrum disorder.

  14. Reduced autobiographical memory specificity is associated with impaired discrimination learning in anxiety disorder patients

    Science.gov (United States)

    Lenaert, Bert; Boddez, Yannick; Vervliet, Bram; Schruers, Koen; Hermans, Dirk

    2015-01-01

    Associative learning plays an important role in the development of anxiety disorders, but a thorough understanding of the variables that impact such learning is still lacking. We investigated whether individual differences in autobiographical memory specificity are related to discrimination learning and generalization. In an associative learning task, participants learned the association between two pictures of female faces and a non-aversive outcome. Subsequently, six morphed pictures functioning as generalization stimuli (GSs) were introduced. In a sample of healthy participants (Study 1), we did not find evidence for differences in discrimination learning as a function of memory specificity. In a sample of anxiety disorder patients (Study 2), individuals who were characterized by low memory specificity showed deficient discrimination learning relative to high specific individuals. In contrast to previous findings, results revealed no effect of memory specificity on generalization. These results indicate that impaired discrimination learning, previously shown in patients suffering from an anxiety disorder, may be—in part—due to limited memory specificity. Together, these studies emphasize the importance of incorporating cognitive variables in associative learning theories and their implications for the development of anxiety disorders. In addition, re-analyses of the data (Study 3) showed that patients suffering from panic disorder showed higher outcome expectancies in the presence of the stimulus that was never followed by an outcome during discrimination training, relative to patients suffering from other anxiety disorders and healthy participants. Because we used a neutral, non-aversive outcome (i.e., drawing of a lightning bolt), these data suggest that learning abnormalities in panic disorder may not be restricted to fear learning, but rather reflect a more general associative learning deficit that also manifests in fear irrelevant contexts. PMID

  15. Thought-action fusion across anxiety disorder diagnoses: specificity and treatment effects.

    Science.gov (United States)

    Thompson-Hollands, Johanna; Farchione, Todd J; Barlow, David H

    2013-05-01

    Thought-action fusion (TAF) is a cognitive error that has been frequently investigated within the context of obsessive-compulsive disorder (OCD). However, evidence suggests that this error may also be present in disorders other than OCD, indicating that TAF is related to higher order factors rather than a specific diagnosis. We explored TAF in a sample of patients with mixed diagnoses undergoing treatment with a transdiagnostic CBT protocol. Elevated TAF levels at baseline were not specific to patients with OCD. However, the presence of any generalized anxiety disorder (GAD) diagnosis was unexpectedly the strongest predictor of likelihood TAF. Likelihood TAF, a particular component of TAF, was reduced after transdiagnostic treatment, and this reduction was not affected by the presence of a GAD diagnosis. Results indicate that TAF is responsive to treatment and should be assessed and, perhaps, treated in disorders beyond OCD.

  16. Specificity of Affective Instability in Patients With Borderline Personality Disorder Compared to Posttraumatic Stress Disorder, Bulimia Nervosa, and Healthy Controls

    Science.gov (United States)

    Santangelo, Philip; Mussgay, Lutz; Sawitzki, Günther; Trull, Timothy J.; Reinhard, Iris; Steil, Regina; Klein, Christoph; Bohus, Martin; Ebner-Priemer, Ulrich W.

    2014-01-01

    Affective instability is a core feature of borderline personality disorder (BPD). The use of advanced assessment methodologies and appropriate statistical analyses has led to consistent findings that indicate a heightened instability in patients with BPD compared with healthy controls. However, few studies have investigated the specificity of affective instability among patients with BPD with regard to relevant clinical control groups. In this study, 43 patients with BPD, 28 patients with posttraumatic stress disorder (PTSD), 20 patients with bulimia nervosa (BN), and 28 healthy controls carried e-diaries for 24 hours and were prompted to rate their momentary affective states approximately every 15 minutes while awake. To quantify instability, we used 3 state-of-the-art indices: multilevel models for squared successive differences (SSDs), multilevel models for probability of acute changes (PACs), and aggregated point-by-point changes (APPCs). Patients with BPD displayed heightened affective instability for emotional valence and distress compared with healthy controls, regardless of the specific instability indices. These results directly replicate earlier studies. However, affective instability did not seem to be specific to patients with BPD. With regard to SSDs, PACs, and APPCs, patients with PTSD or BN showed a similar heightened instability of affect (emotional valence and distress) to that of patients with BPD. Our results give raise to the discussion if affective instability is a transdiagnostic or a disorder-specific mechanism. Current evidence cannot answer this question, but investigating psychopathological mechanisms in everyday life across disorders is a promising approach to enhance validity and specificity of mental health diagnoses. PMID:24661176

  17. Content specificity of attention bias to threat in anxiety disorders: a meta-analysis.

    Science.gov (United States)

    Pergamin-Hight, Lee; Naim, Reut; Bakermans-Kranenburg, Marian J; van IJzendoorn, Marinus H; Bar-Haim, Yair

    2015-02-01

    Despite the established evidence for threat-related attention bias in anxiety, the mechanisms underlying this bias remain unclear. One important unresolved question is whether disorder-congruent threats capture attention to a greater extent than do more general or disorder-incongruent threat stimuli. Evidence for attention bias specificity in anxiety would implicate involvement of previous learning and memory processes in threat-related attention bias, whereas lack of content specificity would point to perturbations in more generic attention processes. Enhanced clarity of mechanism could have clinical implications for the stimuli types used in Attention Bias Modification Treatments (ABMT). Content specificity of threat-related attention bias in anxiety and potential moderators of this effect were investigated. A systematic search identified 37 samples from 29 articles (N=866). Relevant data were extracted based on specific coding rules, and Cohen's d effect size was used to estimate bias specificity effects. The results indicate greater attention bias toward disorder-congruent relative to disorder-incongruent threat stimuli (d=0.28, pattention tasks, or type of disorder-incongruent stimuli. No evidence of publication bias was observed. Implications for threat bias in anxiety and ABMT are discussed. Copyright © 2014 Elsevier Ltd. All rights reserved.

  18. Disease-specific direct-to-consumer advertising for reminding consumers to take medications.

    Science.gov (United States)

    Bhutada, Nilesh S; Rollins, Brent L

    2015-01-01

    To assess the relationship between disease-specific direct-to-consumer (DTC) advertising, via traditional advertising effectiveness measures, and consumers' self-reported medication-taking behavior. Data were gathered for 514 respondents (age 18 and above) using an online survey panel. Participants were exposed to a disease-specific (i.e., nonbranded) DTC advertising for depression. The advertising stimulus created for the study was based on the Food and Drug Administration guidelines for disease-specific DTC advertising and modeled after current print disease-specific DTC advertising. Participants reviewed the advertising stimulus through the online program and then responded to a questionnaire containing closed-ended questions assessing the constructs. Data were analyzed using chi-square tests. All tests were interpreted at an a priori alpha of 0.05. Significantly more respondents who were highly involved, paid more attention to the advertisement, and were responsive to DTC advertisements in the past indicated that the disease-specific DTC advertising stimulus reminded them to take their depression and other medications. These exploratory results show disease-specific DTC advertising can help people remember to take their prescription medication when viewed, which may lead to more positive medication-taking behavior and increased medication adherence. Additionally, given the fair balance and legal issues surrounding product-specific DTC advertising, disease-specific DTC advertising can serve as an effective component of the marketing mix for pharmaceutical manufacturers. Future research should attempt to study the impact of disease-specific DTC advertising on consumers' actual medication adherence using standardized adherence measures such as prescription records.

  19. General, Specific and Unique Cognitive Factors Involved in Anxiety and Depressive Disorders

    OpenAIRE

    Drost, J.; Van der Does, A. J. W.; Antypa, N.; Zitman, F. G.; Van Dyck, R.; Spinhoven, Ph.

    2011-01-01

    Comorbidity among anxiety and depressive disorders is the rule rather than the exception. The Integrative Hierarchical Model proposes that each of these disorders contains general (common to all), specific (common to some) and unique components. However, research into this model is limited and hampered by small (clinical) sample sizes. The aim of the present study is to investigate the incremental validity of the cognitive constructs Anxiety Sensitivity, Pathological Worry and Cognitive React...

  20. Mood and anxiety disorders as early manifestations of medical illness: a systematic review.

    Science.gov (United States)

    Cosci, Fiammetta; Fava, Giovanni A; Sonino, Nicoletta

    2015-01-01

    Affective disturbances involving alterations of mood, anxiety and irritability may be early symptoms of medical illnesses. The aim of this paper was to provide a systematic review of the literature with qualitative data synthesis. MEDLINE, PsycINFO, EMBASE, Cochrane, and ISI Web of Science were systematically searched from inception to February 2014. Search terms were 'prodrome/early symptom', combined using the Boolean 'AND' operator with 'anxiety/depression/mania/hypomania/irritability/irritable mood/hostility', combined with the Boolean 'AND' operator with 'medical illness/medical disorder'. PRISMA guidelines were followed. A total of 21 studies met the inclusion criteria and were analyzed. Depression was found to be the most common affective prodrome of medical disorders and was consistently reported in Cushing's syndrome, hypothyroidism, hyperparathyroidism, pancreatic and lung cancer, myocardial infarction, Wilson's disease, and AIDS. Mania, anxiety and irritability were less frequent. Physicians may not pursue medical workup of cases that appear to be psychiatric in nature. They should be alerted that disturbances in mood, anxiety and irritability may antedate the appearance of a medical disorder.

  1. Don't panic. A guide to tryptophan depletion with disorder-specific anxiety provocation.

    Science.gov (United States)

    Hood, S D; Bell, C J; Argyropoulos, S V; Nutt, D J

    2016-11-01

    The 2002 paper "Does 5-HT restrain panic? A tryptophan depletion study in panic disorder patients recovered on paroxetine" by Bell and colleagues - reprinted in this issue of the Journal - reports on a study undertaken in the halcyon days of David Nutt's Psychopharmacology Unit at the University of Bristol, England. In this invited commentary authors of the original work discuss the impact of this paper on the field of acute tryptophan depletion research (especially in the field of clinical anxiety disorders) and the development of disorder-specific anxiogenic provocations over the past decade. © The Author(s) 2016.

  2. Generic and eating disorder-specific impairment in binge eating disorder with and without overvaluation of weight or shape.

    Science.gov (United States)

    Harrison, Carmel; Mond, Jonathan; Rieger, Elizabeth; Rodgers, Bryan

    2015-09-01

    We sought to elucidate the nature and extent of impairment in quality of life among individuals with binge eating disorder (BED) with and without the overvaluation of weight or shape ("overvaluation"). Subgroups of women - probable BED with overvaluation (n = 102), probable BED without overvaluation (n = 72), obese individuals reporting no binge eating ("obese control", n = 40), and "normal weight" individuals reporting no binge eating ("healthy control," n = 40) - were recruited from a community-based sample in which individuals with eating disorder symptoms were over-represented. They were compared on measures of eating disorder psychopathology and generic and disease-specific measures of quality of life. Scores on these measures among individuals with BED receiving specialist treatment were also considered. Participants with BED and overvaluation had high levels of eating disorder psychopathology and impairment in both generic and disease-specific quality of life, comparable to those of BED patients receiving specialist treatment, and significantly higher than all other subgroups, whereas participants with BED in the absence of overvaluation did not differ from obese controls on any of these measures. The findings provide further evidence for the need to consider reference to overvaluation among the diagnostic criteria for BED. The relative merits of the inclusion of overvaluation as a diagnostic criterion or as a diagnostic specifier for BED warrant greater consideration. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. Cause-specific life-years lost in people with mental disorders

    DEFF Research Database (Denmark)

    Erlangsen, Annette; Andersen, Per Kragh; Toender, Anita

    2017-01-01

    mortality due to medical diseases and disorders among people with mental disorders emphasises the need for future interventions to address these aspects as well as the continued high shares of excess mortality due to alcohol misuse, suicide, and accidents. FUNDING: The Lundbeck Foundation Initiative...... diseases (men: 1·2; women: 0·3), and respiratory diseases (men: 0·3; women: 0·2), and a decrease for suicide (men: -0·7; women: -0·5) and accidents (men: -0·9; women: -0·5). INTERPRETATION: By applying a novel approach, more precise estimates of life-years lost were obtained. The increase in excess...

  4. 76 FR 19692 - Revised Medical Criteria for Evaluating Endocrine Disorders

    Science.gov (United States)

    2011-04-08

    ... failure, vascular disease, and multiple amputations. Response: We will continue to recognize DM as a... blindness, renal failure, vascular disease, and amputations. We are removing only the specific DM listings... example, we evaluate cardiac arrhythmias under 4.00, intestinal necrosis under 5.00, and cerebral edema...

  5. Relationship Between Attention-Deficit/Hyperactivity Disorder Care and Medication Continuity.

    Science.gov (United States)

    Brinkman, William B; Baum, Rebecca; Kelleher, Kelly J; Peugh, James; Gardner, William; Lichtenstein, Phil; Langberg, Joshua; Epstein, Jeffery N

    2016-04-01

    To describe the relationships between attention-deficit/hyperactivity disorder (ADHD) care practices and subsequent medication use. A retrospective cohort from a random sample of medical records in 50 pediatric practices with 188 providers, including 1,352 children who started ADHD medication, was studied. Independent variables included physician behaviors related to medication titration and monitoring of treatment response. Primary outcomes were number of days covered with ADHD medication during the first year of treatment and time from starting medicine to the first 30-day gap in medication supply. Multilevel modeling and Cox proportional hazards regression models were conducted. Children had an average medication supply of 217 days in the first year. Half experienced a 30-day gap in medication supply in the first 3 months. Nearly three-fourths had a medication adjustment in the first year with the first adjustment usually being a dosage change. The average time to the first medication adjustment was over 3 months. Physician's first contact with parents occurred in the first month of treatment for less than half, with the average time being over 2 months. Little variation related to ADHD care quality was accounted for at the physician level. Early titration and early contact were related to greater medication supply and continuity of treatment. Earlier physician-delivered ADHD care (e.g., contact with parent after starting medication and medication adjustment) is related to greater medication supply and continuity. It remains to be determined whether interventions that improve the quality of titration and monitoring practices for children with ADHD would also improve medication continuity. Copyright © 2016 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

  6. The Medical Home for Children with Autism Spectrum Disorders: Parent and Pediatrician Perspectives

    Science.gov (United States)

    Carbone, Paul S.; Behl, Diane D.; Azor, Virgina; Murphy, Nancy A.

    2010-01-01

    This qualitative study examines differences between perceptions of parents and pediatricians regarding the needs of children with autism spectrum disorders (ASDs) and their families within the medical home. Two separate focus groups of parents of children with ASDs and pediatricians were conducted. Parents and pediatricians identify unmet needs…

  7. Psychotropic Medication Trends among Children and Adolescents with Autism Spectrum Disorder in the Medicaid Program

    Science.gov (United States)

    Schubart, Jane R.; Camacho, Fabian; Leslie, Douglas

    2014-01-01

    This study characterized psychotropic medication use among Medicaid-enrolled children and adolescents with autism spectrum disorders by examining trends over time, including length of treatment and polypharmacy using 4 years of administrative claims data from 41 state Medicaid programs (2000-2003). The data set included nearly 3 million children…

  8. Nonmedical Use of Attention-Deficit/Hyperactivity Disorder Medication Among Secondary School Students in The Netherlands

    NARCIS (Netherlands)

    Koster, Ellen S; de Haan, Lydia; Bouvy, Marcel L; Heerdink, Eibert R

    2015-01-01

    OBJECTIVE: No studies in Europe have assessed the extent of nonmedical attention-deficit/hyperactivitiy disorder (ADHD) medication use among adolescents, while also, in Europe, prescribing of these medicines has increased. Our objective was to study the prevalence and motives for nonmedical ADHD

  9. 77 FR 5734 - New Medical Criteria for Evaluating Language and Speech Disorders

    Science.gov (United States)

    2012-02-06

    ...-0778, or visit our Internet site, Social Security Online, at http://www.socialsecurity.gov... SOCIAL SECURITY ADMINISTRATION 20 CFR Part 404 [Docket No. SSA-2006-0179] RIN 0960-AG21 New Medical Criteria for Evaluating Language and Speech Disorders AGENCY: Social Security Administration...

  10. Treatment outcome of alcohol use disorder outpatients with or without medically assisted detoxification

    NARCIS (Netherlands)

    Merkx, Maarten J. M.; Schippers, Gerard M.; Koeter, Maarten W. J.; de Wildt, Wencke A. J. M.; Vedel, Ellen; Goudriaan, Anna E.; van den Brink, Wim

    2014-01-01

    Little is known about the incremental effects of medically assisted detoxification on outpatient treatment for alcohol use disorders. The objective of this study was to compare drinking outcomes in a psychosocial treatment program between two groups of heavy drinking patients who had an alcohol use

  11. Collaborative Strategies for Teaching Common Acid-Base Disorders to Medical Students

    Science.gov (United States)

    Petersen, Marie Warrer; Toksvang, Linea Natalie; Plovsing, Ronni R.; Berg, Ronan M. G.

    2014-01-01

    The ability to recognize and diagnose acid-base disorders is of the utmost importance in the clinical setting. However, it has been the experience of the authors that medical students often have difficulties learning the basic principles of acid-base physiology in the respiratory physiology curriculum, particularly when applying this knowledge to…

  12. Patients taking medications for bipolar disorder are more prone to metabolic syndrome than Korea's general population.

    Science.gov (United States)

    Lee, Nam Young; Kim, Se Hyun; Cho, Belong; Lee, Yeon Ji; Chang, Jae Seung; Kang, Ung Gu; Kim, Yong Sik; Ahn, Yong Min

    2010-10-01

    Despite growing concerns about the co-morbidity of metabolic syndrome (MetS) and bipolar disorder, few studies have been conducted on this topic in Asian populations. This study examined Korean patients with bipolar disorder to assess its co-morbidity with MetS and to compare the prevalence of MetS in patients with medication for bipolar disorder with that of healthy patients. We used cross-sectional data from the medical records of patients with bipolar disorder who presented to the psychiatric clinic in Seoul National University Hospital between June 2007 and June 2008. The control group, matched for age and gender, was randomly drawn from visitors to the Health Promotion Center at the same hospital during the same period. We compared the prevalence of MetS between these two groups with independent sample t-tests and chi-squared tests. We also calculated the indirectly standardized prevalence ratio (ISPR) with a standardization that used the Fourth Korean National Health and Nutrition Examination Survey (KNHNES, 2007). The prevalence of MetS in patients who took medication for bipolar disorder (N=152) was 27.0%, 25.0% and 25.7%, based on the definitions of the American Heart Association and the National Heart, Lung and Blood Institute's adaptation of the Adult Treatment Panel III (AHA), the National Cholesterol Education Program for Adult Treatment Panel III (ATPIII) and the International Diabetes Federation (IDF), respectively. The present study determined that the prevalence of MetS was significantly higher in patients with bipolar disorder than in the control group; the odds ratios (OR) (95% CI) were 2.44 (1.35-4.40), 2.48 (1.34-4.59) and 2.57 (1.40-4.74), based on the definition of the AHA, ATPIII and IDF, respectively. The ISPR (95% CI) was 1.48 (1.02-1.93), 1.54 (1.05-2.03) and 1.98 (1.36-2.60), respectively. Patients with medications for bipolar disorder showed a significantly higher prevalence of increased waist circumference, elevated triglycerides, and

  13. Priapism associated with the use of stimulant medications and atomoxetine for attention-deficit/hyperactivity disorder in children.

    Science.gov (United States)

    Eiland, Lea S; Bell, Edward A; Erramouspe, John

    2014-10-01

    To review the association of priapism with stimulant medications and atomoxetine commonly used in the treatment of attention-deficit/hyperactivity disorder (ADHD). A comprehensive literature search was conducted through PubMed (1966-May 15, 2014) using the search terms priapism, methylphenidate, amphetamine, atomoxetine, attention-deficit disorder with hyperactivity, and pediatrics. Google Scholar, Scopus, and the Food and Drug Administration (FDA) Web site were also searched. References from identified literature were also reviewed. All identified literature focused on ADHD treatment. Literature regarding priapism caused by methylphenidate, amphetamines, and atomoxetine were included. Stimulant medications and atomoxetine have been linked to the occurrence of priapism in children. Specifically, methylphenidate has been implicated in a recent FDA safety announcement warning as a result of 15 case reports (mean age = 12.5 years), and thus, the drug label and medication guides have been updated to reflect this concern. Prolonged erections and priapism occurred with immediate- and long-acting products, dose increases, and drug withdrawal periods. Priapism has also occurred in 4 patients taking amphetamines and one 11-year-old patient taking atomoxetine for ADHD. Priapism has been associated with stimulants, amphetamines, and atomoxetine use for ADHD in children. Providers and health care practitioners should educate male patients prescribed these ADHD medications as well as caregivers regarding the signs, symptoms, and complications with priapism. Discontinuation and evaluation of the medication is warranted if this adverse drug reaction occurs. Depending on the priapism subtype, other products may be initiated or medications not associated with priapism may be utilized. © The Author(s) 2014.

  14. Prevalence of Sleep Disorder among Medical Students in an Eastern University in Iran

    Directory of Open Access Journals (Sweden)

    Mohsen Heidari Mokarrar

    2017-03-01

    Full Text Available Background: Sleep disorder is mostly an early manifestation of psychological diseases. It is defined as disturbances in the regularity, quality and quantity of sleep as well as daily activity. Methods: In this cross-sectional study, 200 medical students were assessed for sleep status using SHQ and GHQ questionnaires. Data analysis was carried out using descriptive statistics (mean, standard deviation, frequency and Chi square test through the statistical package of SPSS V.16. Results: The frequency of sleep disorder among students was found to be 21.5%., which was significantly more common among older students (p<0.05, males (p=0.005, employed students (p=0.004, smokers (p=0.001, and those with other psychological disorders (p=0.001. Conclusion: Sleep disorders were higher among students who were men, smokers, or had psychological disorders, and were also employed students. Although a considerable group of medical students were found to be suffering from sleep disorders, this prevalence was lower than those reported in the previous studies.

  15. Mood, anxiety, and alcohol use disorders and later cause-specific sick leave in young adult employees

    Directory of Open Access Journals (Sweden)

    Fartein Ask Torvik

    2016-08-01

    Full Text Available Abstract Background Mental disorders strongly influence work capability in young adults, but it is not clear which disorders that are most strongly associated with sick leave, and which diagnoses that are stated on the sick leave certificates. Better knowledge of the impairments associated with different mental disorders is needed for optimal planning of interventions and prioritization of health services. In the current study, we investigate the prospective associations between eight mood, anxiety, and alcohol use disorders, and later sick leave granted for mental, somatic, or any disorder. Methods Lifetime mental disorders were assessed by structured diagnostic interviews in 2,178 young adults followed for eight years with registry data on sick leave. Relative risk ratios were estimated for the associations between each mental disorder and the different forms of sick leave. Results All included diagnoses were associated with later sick leave. In adjusted analyses, major depressive disorder and generalized anxiety disorder were the strongest predictors of sick leave granted for mental disorders, whereas social anxiety disorder and specific phobia were the strongest predictors of sick leave granted for somatic disorders. Specific phobia and major depressive disorder had the highest attributable fractions for all-cause sick leave. Conclusions Mood and anxiety disorders constituted independent risk factors for all cause sick leave, whereas alcohol use disorders seemed to be of less importance in young adulthood. Disorders characterised by distress were most strongly associated with sick leave granted for mental disorders, whereas disorders characterised by fear primarily predicted sick leave granted for somatic conditions. A large part of all sick leave is related to specific phobia, due to the high prevalence of this disorder. The impairment associated with this common disorder may be under-acknowledged, and it could decrease work capacity among

  16. Mood, anxiety, and alcohol use disorders and later cause-specific sick leave in young adult employees.

    Science.gov (United States)

    Torvik, Fartein Ask; Reichborn-Kjennerud, Ted; Gjerde, Line C; Knudsen, Gun Peggy; Ystrom, Eivind; Tambs, Kristian; Røysamb, Espen; Østby, Kristian; Ørstavik, Ragnhild

    2016-08-03

    Mental disorders strongly influence work capability in young adults, but it is not clear which disorders that are most strongly associated with sick leave, and which diagnoses that are stated on the sick leave certificates. Better knowledge of the impairments associated with different mental disorders is needed for optimal planning of interventions and prioritization of health services. In the current study, we investigate the prospective associations between eight mood, anxiety, and alcohol use disorders, and later sick leave granted for mental, somatic, or any disorder. Lifetime mental disorders were assessed by structured diagnostic interviews in 2,178 young adults followed for eight years with registry data on sick leave. Relative risk ratios were estimated for the associations between each mental disorder and the different forms of sick leave. All included diagnoses were associated with later sick leave. In adjusted analyses, major depressive disorder and generalized anxiety disorder were the strongest predictors of sick leave granted for mental disorders, whereas social anxiety disorder and specific phobia were the strongest predictors of sick leave granted for somatic disorders. Specific phobia and major depressive disorder had the highest attributable fractions for all-cause sick leave. Mood and anxiety disorders constituted independent risk factors for all cause sick leave, whereas alcohol use disorders seemed to be of less importance in young adulthood. Disorders characterised by distress were most strongly associated with sick leave granted for mental disorders, whereas disorders characterised by fear primarily predicted sick leave granted for somatic conditions. A large part of all sick leave is related to specific phobia, due to the high prevalence of this disorder. The impairment associated with this common disorder may be under-acknowledged, and it could decrease work capacity among individuals with somatic disorders. This disorder has good treatment

  17. Anxiety and depressive symptoms and medical illness among adults with anxiety disorders.

    Science.gov (United States)

    Niles, Andrea N; Dour, Halina J; Stanton, Annette L; Roy-Byrne, Peter P; Stein, Murray B; Sullivan, Greer; Sherbourne, Cathy D; Rose, Raphael D; Craske, Michelle G

    2015-02-01

    Anxiety is linked to a number of medical conditions, yet few studies have examined how symptom severity relates to medical comorbidity. The current study assessed associations between severity of anxiety and depression and the presence of medical conditions in adults diagnosed with anxiety disorders. Nine-hundred eighty-nine patients diagnosed with panic, generalized anxiety, social anxiety, and posttraumatic stress disorders reported on the severity of anxiety and depressive symptoms and on diagnoses of 11 medical conditions. Severity of anxiety and depressive symptoms was strongly associated with having more medical conditions over and above control variables, and the association was as strong as that between BMI and disease. Odds of having asthma, heart disease, back problems, ulcer, migraine headache and eyesight difficulties also increased as anxiety and depressive symptom severity increased. Anxiety symptoms were independently associated with ulcer, whereas depressive symptoms were independently associated with heart disease, migraine, and eyesight difficulties. These findings add to a growing body of research linking anxiety disorders with physical health problems and indicate that anxiety and depressive symptoms deserve greater attention in their association with disease. Copyright © 2014 Elsevier Inc. All rights reserved.

  18. Prevalence of Body Dysmorphic Disorder and its Association With Body Features in Female Medical Students.

    Science.gov (United States)

    Shaffi Ahamed, Shaik; Enani, Jawaher; Alfaraidi, Lama; Sannari, Lujain; Algain, Rihaf; Alsawah, Zainah; Al Hazmi, Ali

    2016-06-01

    Body dysmorphic disorder (BDD) is a distressing psychiatric disorder. So far there have not been any studies on BDD in Saudi Arabia. The aim of this study was to determine the prevalence of body dysmorphic disorder in female medical students and to investigate whether there is an association between BDD and body features of concern, social anxiety and symptoms of BDD. A cross sectional study was carried out on female medical students of the college of medicine, King Saud University, Riyadh, Saudi Arabia during January to April, 2015. Data were collected using the body image disturbance questionnaire, Body dysmorphic disorder symptomatology and social interaction anxiety scale. Descriptive statistics, bivariate and multivariate analysis were used to analyze the results. Out of 365 students who filled out the questionnaire, 4.4% (95% confidence intervals (CI): 2.54% to 7.04%) were positive for BDD with skin (75%) and fat (68.8%) as the most frequent body features of concern. Ten features (skin, fat, chest, hips, buttocks, arms, legs, lips, fingers, and shoulders) out of twenty-six were significantly associated with BDD. Arms and chest were independently associated with BDD. The odds of presence of body concern related to "arms" was 4.3 (95% C.I: 1.5, 12.1) times more in BDD subjects than non-BDD subjects, while concern about "chest" was 3.8 (1.3, 10.9) times more when compared to non-BDD subjects. No statistically significant association was observed between BDD and social anxiety (P = 0.13). This was the first study conducted in Kingdom of Saudi Arabia (KSA) on female medical students, which quantified the prevalence of BDD and identified the body features associated with it. Body dysmorphic disorder is prevalent in female medical students but it is relatively rare and an unnoticed disorder.

  19. Perceived treatment effectiveness, medication compliance, and complementary and alternative medicine use among veterans with bipolar disorder.

    Science.gov (United States)

    Jarman, Christopher N; Perron, Brian E; Kilbourne, Amy M; Teh, Carrie Farmer

    2010-03-01

    Recent research shows a high rate of complementary and alternative medicine (CAM) use among persons with mental disorders, although correlates and patterns of CAM use are relatively unknown. This study tested whether CAM use is associated with perceived effectiveness of conventional treatment (i.e., psychotropic medication and psychotherapy) and medication compliance among persons with bipolar disorder. Patients with bipolar disorder (n = 435) were included as part of a naturalistic cohort study. Measures of CAM utilization, medication compliance, and perceptions of the effectiveness of psychotropic medications and psychotherapy were based on previously established questionnaires. Associations were tested using bivariate and multivariate analyses. Bivariate analyses showed that patients who did not perceive psychotherapy as effective at improving social, family, or job functioning reported greater CAM use. However, medication compliance was not significantly associated with use of CAM. Patients who used oral (e.g., herbal therapies) or cognitive (e.g., meditation) CAM were more likely to report that their medications were not effective at relieving manic or depressive symptoms. Users of cognitive CAM were more likely to report that their medications did not help with social, job, or family functioning, and that they did not prevent recurrences of manic or depressive episodes. None of the bivariate associations remained significant in multivariate analyses. Prior research has suggested that persons who are dissatisfied with treatment for medical conditions are more likely to use CAM therapies. However, the results of this study do not show CAM therapies to be associated with perceived effectiveness of treatments for mental health problems among this sample of persons with serious mental illnesses. This suggests that motivations for CAM use may vary by population and condition. Because few correlates of CAM use among persons with serious mental illnesses are known

  20. Interpretation and expectation in childhood anxiety disorders: age effects and social specificity.

    Science.gov (United States)

    Creswell, Cathy; Murray, Lynne; Cooper, Peter

    2014-01-01

    Theory and treatment for childhood anxiety disorders typically implicates children's negative cognitions, yet little is known about the characteristics of thinking styles of clinically anxious children. In particular, it is unclear whether differences in thinking styles between children with anxiety disorders and non-anxious children vary as a function of child age, whether particular cognitive distortions are associated with childhood anxiety disorders at different child ages, and whether cognitive content is disorder-specific. The current study addressed these questions among 120 7-12 year old children (53% female) who met diagnostic criteria for social anxiety disorder, other anxiety disorder, or who were not currently anxious. Contrary to expectations, threat interpretation was not inflated amongst anxious compared to non-anxious children at any age, although older (10-12 year old) anxious children did differ from non-anxious children on measures of perceived coping. The notion of cognitive-content specificity was not supported across the age-range. The findings challenge current treatment models of childhood anxiety, and suggest that a focus on changing anxious children's cognitions is not warranted in mid-childhood, and in late childhood cognitive approaches may be better focussed on promoting children's perceptions of control rather than challenging threat interpretations.

  1. Co-morbid anxiety disorders in bipolar disorder and major depression: familial aggregation and clinical characteristics of co-morbid panic disorder, social phobia, specific phobia and obsessive-compulsive disorder.

    Science.gov (United States)

    Goes, F S; McCusker, M G; Bienvenu, O J; Mackinnon, D F; Mondimore, F M; Schweizer, B; Depaulo, J R; Potash, J B

    2012-07-01

    Co-morbidity of mood and anxiety disorders is common and often associated with greater illness severity. This study investigates clinical correlates and familiality of four anxiety disorders in a large sample of bipolar disorder (BP) and major depressive disorder (MDD) pedigrees. The sample comprised 566 BP families with 1416 affected subjects and 675 MDD families with 1726 affected subjects. Clinical characteristics and familiality of panic disorder, social phobia, specific phobia and obsessive-compulsive disorder (OCD) were examined in BP and MDD pedigrees with multivariate modeling using generalized estimating equations. Co-morbidity between mood and anxiety disorders was associated with several markers of clinical severity, including earlier age of onset, greater number of depressive episodes and higher prevalence of attempted suicide, when compared with mood disorder without co-morbid anxiety. Familial aggregation was found with co-morbid panic and OCD in both BP and MDD pedigrees. Specific phobia showed familial aggregation in both MDD and BP families, although the findings in BP were just short of statistical significance after adjusting for other anxiety co-morbidities. We found no evidence for familiality of social phobia. Our findings suggest that co-morbidity of MDD and BP with specific anxiety disorders (OCD, panic disorder and specific phobia) is at least partly due to familial factors, which may be of relevance to both phenotypic and genetic studies of co-morbidity.

  2. The Genetic Intersection of Neurodevelopmental Disorders and Shared Medical Comorbidities – Relations that Translate from Bench to Bedside

    Directory of Open Access Journals (Sweden)

    Jamsine Plummer

    2016-08-01

    Full Text Available Most psychiatric disorders are considered neurodevelopmental, and the associated genes often are expressed in tissues outside of the brain. This suggests a biological relatedness with medical co-occurrences that could have broad clinical implications for diagnosis and patient management over a lifetime. A qualitative integration of public data from genetic consortia of psychiatric disorders and medical comorbidities explores the question of whether genetically associated psychiatric illnesses present with co-occurring disturbances can be used to define specific mental-physical health relations. Novel patterns of gene-disorder relations appear with approximately one-third of conservatively defined, consortia-generated candidate risk genes with multiple psychiatric diagnoses. Moreover, nearly as many genes overlap with non-psychiatric phenotypes, including cardiovascular, renal, respiratory and metabolic disturbances. While the landscape of genetic risk will change as study populations are expanded and biological confirmations accrue, the current relationships suggest that a mostly siloed perspective of gene relatedness to one categorical psychiatric diagnosis is not clinically useful. The future holds the promise that once candidates are fully validated, genome screening and mutation identification will bring more precision for predicting the risk for complex health conditions. Our view is that as genetic data is refined, continuing to decipher a shared pattern of genetic risk for brain and peripheral organ pathophysiology is not simply an academic exercise. Rather, determining relatedness will impact predictions of multifaceted health risks, patient treatment and management.

  3. Attention-Deficit/Hyperactivity Disorder-Specific Stimulant Misuse, Mood, Anxiety, and Stress in College-Age Women at High Risk for or with Eating Disorders

    Science.gov (United States)

    Gibbs, Elise L.; Kass, Andrea E.; Eichen, Dawn M.; Fitzsimmons-Craft, Ellen E.; Trockel, Mickey; Wilfley, Denise E.; Taylor, C. Barr

    2016-01-01

    Objective: To examine the misuse of attention-deficit/hyperactivity disorder (ADHD)-specific stimulants in a college population at high risk for or with clinical or subclinical eating disorders. Participants: Four hundred forty-eight college-age women aged 18-25 at high risk for or with a clinical or subclinical eating disorder. Methods:…

  4. Primary Headache Disorders- Part 2: Tension-type headache and medication overuse headache.

    Science.gov (United States)

    Jay, Gary W; Barkin, Robert L

    2017-12-01

    In Part 2 of Primary Headache disorders, we discuss the fourth Primary Headache Disorder, Tension-Type Headache (TTHA). We are again using the ICHD-III (Beta) definitions of such headaches, taking into consideration episodic and chronic TTHA, as well as the presence or absence of pericranial muscle tenderness. We discuss the pathophysiology and pharmacotherapeutic treatment of TTHA, and the aspects of the Myofascial Pain Syndrome that enhance and help the development of TTHA. We then discuss Medication Overuse Headache (MOH), itself a Secondary headache disorder, but one that is extremely important as it assists with the chronification of both migraine and TTHA. Finally we discuss how to manage and treat those patients with MOH. Chronic migraine, which is TTHA, Migraine as well as, in many patients, MOH, is discussed along with the treatment of this multifaceted disorder. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Medical Treatment for Burn Patients with Eating Disorders: A Case Report

    Directory of Open Access Journals (Sweden)

    Minekatsu Akimoto

    2011-01-01

    Full Text Available There have been many cases of burn patients who also suffer from psychiatric problems, including eating disorders. We present a case of a 38-year-old female with an eating disorder and depression who became light-headed and fell, spilling boiling water from a kettle on herself at home sustaining partial thickness and full thickness burns over 5% of her total body surface area: left buttock and right thigh and calf. Eating disorders (in the present case, anorexia nervosa cause emaciation and malnutrition, and consent for hospitalization from the patient and/or family is often difficult. During the medical treatment of burns for these patients, consideration not only of physical symptoms caused by malnutrition but also the psychiatric issues is required. Therefore, multifaceted and complex care must be given to burn patients with eating disorders.

  6. Post-traumatic stress disorder and medication adherence: results from the Mind Your Heart study.

    Science.gov (United States)

    Kronish, Ian M; Edmondson, Donald; Li, Yongmei; Cohen, Beth E

    2012-12-01

    Patients with post-traumatic stress disorder (PTSD) are at increased risk for adverse outcomes from comorbid medical conditions. Medication non-adherence is a potential mechanism explaining this increased risk. We examined the association between PTSD and medication adherence in a cross-sectional study of 724 patients recruited from two Department of Veterans Affairs Medical Centers between 2008 and 2010. PTSD was assessed using the Clinician Administered PTSD Scale. Medication adherence was assessed using a standardized questionnaire. Ordinal logistic regression models were used to calculate the odds ratios (ORs) for medication non-adherence in patients with versus without PTSD, adjusting for potential confounders. A total of 252 patients (35%) had PTSD. Twelve percent of patients with PTSD reported not taking their medications as prescribed compared to 9% of patients without PTSD (unadjusted OR 1.85, 95% CI 1.37-2.50, Pversus 13%; unadjusted OR 2.01, 95% CI 1.44-2.82, P<0.001). The association between PTSD and non-adherence remained significant after adjusting for demographics, depression, alcohol use, social support, and medical comorbidities (adjusted OR 1.47, 95% CI 1.03-2.10, P=0.04 for not taking medications as prescribed and 1.95, 95% CI 1.31-2.91, P=0.001 for skipping medications). PTSD was associated with medication non-adherence independent of psychiatric and medical comorbidities. Medication non-adherence may contribute to the increased morbidity and mortality observed in patients with PTSD. Copyright © 2012 Elsevier Ltd. All rights reserved.

  7. Disorder-specific and shared neurophysiological impairments of attention and inhibition in women with attention-deficit/hyperactivity disorder and women with bipolar disorder.

    Science.gov (United States)

    Michelini, G; Kitsune, G L; Hosang, G M; Asherson, P; McLoughlin, G; Kuntsi, J

    2016-02-01

    In adults, attention-deficit/hyperactivity disorder (ADHD) and bipolar disorder (BD) have certain overlapping symptoms, which can lead to uncertainty regarding the boundaries of the two disorders. Despite evidence of cognitive impairments in both disorders separately, such as in attentional and inhibitory processes, data on direct comparisons across ADHD and BD on cognitive-neurophysiological measures are as yet limited. We directly compared cognitive performance and event-related potential measures from a cued continuous performance test in 20 women with ADHD, 20 women with BD (currently euthymic) and 20 control women. The NoGo-N2 was attenuated in women with BD, reflecting reduced conflict monitoring, compared with women with ADHD and controls (both p < 0.05). Both ADHD and BD groups showed a reduced NoGo-P3, reflecting inhibitory control, compared with controls (both p < 0.05). In addition, the contingent negative variation was significantly reduced in the ADHD group (p = 0.05), with a trend in the BD group (p = 0.07), compared with controls. These findings indicate potential disorder-specific (conflict monitoring) and overlapping (inhibitory control, and potentially response preparation) neurophysiological impairments in women with ADHD and women with BD. The identified neurophysiological parameters further our understanding of neurophysiological impairments in women with ADHD and BD, and are candidate biomarkers that may aid in the identification of the diagnostic boundaries of the two disorders.

  8. Nonmedical Use of Attention-Deficit/Hyperactivity Disorder Medication Among Secondary School Students in The Netherlands.

    Science.gov (United States)

    Koster, Ellen S; de Haan, Lydia; Bouvy, Marcel L; Heerdink, Eibert R

    2015-10-01

    No studies in Europe have assessed the extent of nonmedical attention-deficit/hyperactivitiy disorder (ADHD) medication use among adolescents, while also, in Europe, prescribing of these medicines has increased. Our objective was to study the prevalence and motives for nonmedical ADHD medication use among secondary school students in the Netherlands. Adolescent students 10-19 years of age from six secondary schools were invited to complete an online survey on use of ADHD medication, tobacco, alcohol, and drugs. Nonmedical ADHD medication use was defined as self-reported use without a prescription during the previous 12 months. Survey data were available for 777 students (15% response rate). The overall proportion of students self-reporting nonmedical ADHD medication use was 1.2% (n = 9), which represented almost 20% of the adolescents who reported ADHD medication use (n = 49). Most adolescents reported self-medication or enhancing study performance as motives for ADHD medication use. The proportion of the study sample reporting nonmedical ADHD medication use in our study is lower compared with that in previous research conducted in the United States and Canada; however, on a population-based level, there might be a considerable proportion of recreational users.

  9. Pattern of neural responses to verbal fluency shows diagnostic specificity for schizophrenia and bipolar disorder

    Directory of Open Access Journals (Sweden)

    Walshe Muriel

    2011-01-01

    Full Text Available Abstract Background Impairments in executive function and language processing are characteristic of both schizophrenia and bipolar disorder. Their functional neuroanatomy demonstrate features that are shared as well as specific to each disorder. Determining the distinct pattern of neural responses in schizophrenia and bipolar disorder may provide biomarkers for their diagnoses. Methods 104 participants underwent functional magnetic resonance imaging (fMRI scans while performing a phonological verbal fluency task. Subjects were 32 patients with schizophrenia in remission, 32 patients with bipolar disorder in an euthymic state, and 40 healthy volunteers. Neural responses to verbal fluency were examined in each group, and the diagnostic potential of the pattern of the neural responses was assessed with machine learning analysis. Results During the verbal fluency task, both patient groups showed increased activation in the anterior cingulate, left dorsolateral prefrontal cortex and right putamen as compared to healthy controls, as well as reduced deactivation of precuneus and posterior cingulate. The magnitude of activation was greatest in patients with schizophrenia, followed by patients with bipolar disorder and then healthy individuals. Additional recruitment in the right inferior frontal and right dorsolateral prefrontal cortices was observed in schizophrenia relative to both bipolar disorder and healthy subjects. The pattern of neural responses correctly identified individual patients with schizophrenia with an accuracy of 92%, and those with bipolar disorder with an accuracy of 79% in which mis-classification was typically of bipolar subjects as healthy controls. Conclusions In summary, both schizophrenia and bipolar disorder are associated with altered function in prefrontal, striatal and default mode networks, but the magnitude of this dysfunction is particularly marked in schizophrenia. The pattern of response to verbal fluency is highly

  10. [Analysis of medical cost of atlantoaxial disorders in patients receiving innovated treatment technologies].

    Science.gov (United States)

    Wu, Yunxia; Liu, Zhongjun

    2016-01-19

    To explore the effects of innovated technologies and products on improving outcomes and decreasing medical costs by analyzing a total and subtotal medical costs of patients with atlantoaxial disorders. The medical costs of 1 489 patients with atlantoaxial disorders from Peking University Third Hospital from 2005 to 2014, who received innovated technologies and products treatment were retrospectively analyzed and compared.Descriptive analysis and ANOVA were used for statistical analysis, and SPSS 19.0 was used to analyze data. From 2005 to 2014, under the situation of a general increase in medical cost by 327%, the total medical costs were stable for patients who used innovated technologies and products for treatment, fluctuating from 20 851 in 2005 to 20 878 in 2014; however, the cases of operation increased year by year, from 88 in 2005 to 163 in 2014; the average length of stay decreased from 21 in 2005 to 10 in 2014; the total cases of transfusion were 22 from 2005 to 2014; the safety, stability and feasibility of the innovated technologies and products were illustrated through the decrease of average length of stay, the reduction of bleeding and the significance of outcomes. It is illustrated that the innovated technologies and products not only decrease patients' suffering and medical costs but also are safe, stable and feasible.

  11. Prevalence of major depressive disorder in patients receiving beta-blocker therapy versus other medications.

    Science.gov (United States)

    Carney, R M; Rich, M W; teVelde, A; Saini, J; Clark, K; Freedland, K E

    1987-08-01

    Depression is believed to be a common side effect in patients receiving beta-blocker therapy. However, diagnoses of depression defined by current diagnostic criteria may not be more common in patients receiving beta-blockers than in patients with the same medical disorder receiving other medications. Seventy-seven patients undergoing elective cardiac catheterization for evaluation of chest pain received a semi-structured diagnostic psychiatric interview. Twenty-one percent of the patients receiving beta-blockers and 33 percent of the patients receiving medications other than beta-blockers met the current American Psychiatric Association criteria for major depressive disorder (DSM-III) (p = NS). The mean heart rate and state anxiety scores for patients taking beta-blockers were significantly lower than those measured in patients taking medications other than beta-blockers. No other medical or demographic differences were observed between the two groups. Despite the methodologic limitations of the study, there does not appear to be a difference in the point prevalence of depression between patients receiving beta-blockers and those receiving other medications.

  12. Specifically altered brain responses to threat in generalized anxiety disorder relative to social anxiety disorder and panic disorder

    Directory of Open Access Journals (Sweden)

    Christine Buff

    2016-01-01

    Conclusion: The findings present the first evidence for GAD-specific neural correlates of hyper-responsive threat processing, possibly reflecting exaggerated threat sensitivity, maladaptive appraisal and attention-allocation processes.

  13. Work-related risk factors for specific shoulder disorders: a systematic review and meta-analysis

    NARCIS (Netherlands)

    van der Molen, Henk F.; Foresti, Chiara; Daams, Joost G.; Frings-Dresen, Monique H. W.; Kuijer, P. Paul F. M.

    2017-01-01

    The objective of this systematic review and metaanalysis is to examine which work-related risk factors are associated with specific soft tissue shoulder disorders. We searched the electronic databases of Medline and Embase for articles published between 2009 and 24 March 2016 and included the

  14. Specificity and generalization of attentional bias in sexual trauma victims suffering from posttraumatic stress disorder

    NARCIS (Netherlands)

    Fleurkens, P.F.T.; Rinck, M.; Minnen, A. van

    2011-01-01

    The present study investigated specificity of attentional biases for trauma-related stimuli using an Emotional Stroop Task. Participants were 14 women suffering from posttraumatic stress disorder (PTSD) who had experienced a sexual trauma and 24 healthy non-traumatized women. They were asked to name

  15. Graduation Prospects of College Students with Specific Learning Disorder and Students with Mental Health Related Disabilities

    Science.gov (United States)

    Jorgensen, Mary; Budd, Jillian; Fichten, Catherine S.; Nguyen, Mai N.; Havel, Alice

    2018-01-01

    This study's goal was to compare aspects related to academic persistence of two groups of college students with non-visible disabilities: 110 Canadian two and four-year college students--55 with mental health related disabilities and 55 with Specific Learning Disorder (LD). Results show that students with mental health related disabilities were…

  16. Spoken Word Recognition in Adolescents with Autism Spectrum Disorders and Specific Language Impairment

    Science.gov (United States)

    Loucas, Tom; Riches, Nick; Baird, Gillian; Pickles, Andrew; Simonoff, Emily; Chandler, Susie; Charman, Tony

    2013-01-01

    Spoken word recognition, during gating, appears intact in specific language impairment (SLI). This study used gating to investigate the process in adolescents with autism spectrum disorders plus language impairment (ALI). Adolescents with ALI, SLI, and typical language development (TLD), matched on nonverbal IQ listened to gated words that varied…

  17. Working Memory and Learning in Children with Developmental Coordination Disorder and Specific Language Impairment

    Science.gov (United States)

    Alloway, Tracy Packiam; Archibald, Lisa

    2008-01-01

    The authors compared 6- to 11-year-olds with developmental coordination disorder (DCD) and those with specific language impairment (SLI) on measures of memory (verbal and visuospatial short-term and working memory) and learning (reading and mathematics). Children with DCD with typical language skills were impaired in all four areas of memory…

  18. Neurological Soft Signs in Indian Children with Specific Developmental Disorders of Scholastic Skills

    Science.gov (United States)

    Sadhu, Raja; Mehta, Manju; Kalra, Veena; Sagar, Rajesh; Mongia, Monica

    2008-01-01

    Aim: To compare the occurrence of neurological soft signs (NSS) in children with specific developmental disorders of scholastic skills (SDDSS) and normal children. Methods: 36 cases of SDDSS were compared with 30 control children regarding sociodemographic and clinical variables and neurological soft signs. Results: Children with SDDSS had…

  19. Sensitivity and Specificity of Proposed DSM-5 Criteria for Autism Spectrum Disorder in Toddlers

    Science.gov (United States)

    Barton, Marianne L.; Robins, Diana L.; Jashar, Dasal; Brennan, Laura; Fein, Deborah

    2013-01-01

    Autism spectrum disorder (ASD) diagnosis is based on behavioral presentation; changes in conceptual models or defining behaviors may significantly impact diagnosis and uptake of ASD-specific interventions. The literature examining impact of DSM-5 criteria is equivocal. Toddlers may be especially vulnerable to the stringent requirements of…

  20. Ergonomic Intervention Effect in Reducing Musculoskeletal Disorders in Staff of Shiraz Medical School

    Directory of Open Access Journals (Sweden)

    Keyvan Pakshir

    2012-05-01

    Full Text Available Background and aims: High percentage of musculoskeletal disorders occurs due to awkward working posture and poor workstation design. So this study was conducted to determine the prevalence rate of musculoskeletal disorders , evaluate workstations and investigate the effectiveness of ergonomic interventional measures among medical school staff of Shiraz University of Medical Sciences (SUMS.   Methods: In this interventional study, 200 employees of different units of medical school of SUMS participated. They were randomly divided into experimental and control groups. Data were collected via anonymous questionnaire, RULA and QEC techniques as well as an ergonomic workstation checklist that was used to evaluate working conditions.   Results: The results showed that after conducting interventional program for the experimental group there was a significant relationship between employees' increased awareness of ergonomics and workstation improvement (p≤0.05. Additionally, the prevalence rate of reported musculoskeletal disorders in experimental group was significantly reduced following intervention (p≤0.05. After corrective measures, level of risk was decreased and working postures were improved. A significant relationship was observed between risk levels and neck and shoulder pain in the experimental group (p≤0.05 . Following the intervention, workstations scores were increased significantly. Conclusion: On the basis of the findings of this study, it could be noted that the ergonomic interventional program was effective to improve working posture and workstations as well as to reduce the prevalence of musculoskeletal disorders among the staff.

  1. Caregiver perspective on pediatric attention-deficit/hyperactivity disorder: medication satisfaction and symptom control

    Directory of Open Access Journals (Sweden)

    Fridman M

    2017-02-01

    Full Text Available Moshe Fridman,1 Tobias Banaschewski,2 Vanja Sikirica,3 Javier Quintero,4 M Haim Erder,3 Kristina S Chen5 1AMF Consulting, Inc., Los Angeles, CA, USA; 2Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany; 3Global Health Economics Outcomes Research and Epidemiology, Shire, Wayne, PA, USA; 4Psychiatry Department, Hospital Universitario Infanta Leonor, Complutense University, Madrid, Spain; 5Global Health Economics Outcomes Research and Epidemiology, Shire, Lexington, MA, USA Abstract: The caregiver perspective on pediatric attention-deficit/hyperactivity disorder (ADHD study (CAPPA was a web-based, cross-sectional survey of caregivers of children and adolescents (6–17 years of age with ADHD and was conducted in 10 European countries. CAPPA included caregiver assessments of global medication satisfaction, global symptom control, and satisfaction with ADHD medication attributes. Overall, 2,326 caregiver responses indicated that their child or adolescent was currently receiving ADHD medication and completed the “off medication” assessment required for inclusion in the present analyses. Responses to the single-item global medication satisfaction question indicated that 88% were satisfied (moderately satisfied to very satisfied with current medication and 18% were “very satisfied” on the single-item question. Responses to the single-item global symptom control question indicated that 47% and 19% of caregivers considered their child or adolescent’s symptoms to be “controlled” or “very well controlled”, respectively. Significant variations in response to the questions of medication satisfaction and symptom control were observed between countries. The correlation between the global medication satisfaction and global symptom control questions was 0.677 (P<0.001. Global medication satisfaction was significantly

  2. A theoretical approach to medication adherence for children and youth with psychiatric disorders.

    Science.gov (United States)

    Charach, Alice; Volpe, Tiziana; Boydell, Katherine M; Gearing, Robin E

    2008-01-01

    This article provides a theoretical review of treatment adherence for children and youth with psychiatric disorders where pharmacological agents are first-line interventions. Four empirically based models of health behavior are reviewed and applied to the sparse literature about medication adherence for children with attention-deficit/hyperactivity disorder and young people with first-episode psychosis. Three qualitative studies of medication use are summarized, and details from the first-person narratives are used to illustrate the theoretical models. These studies indicate, when taken together, that the clinical approach to addressing poor medication adherence in children and youth with psychiatric disorders should be guided by more than one theoretical model. Mental health experts should clarify beliefs, address misconceptions, and support exploration of alternative treatment options unless contraindicated. Recognizing the larger context of the family, allowing time for parents and children to change their attitudes, and offering opportunities for easy access to medication in the future are important ways of respecting patient preferences, while steering them toward best-evidence interventions. Future research using qualitative methods of inquiry to investigate parent, child, and youth experiences of mental health interventions should identify effective ways to improve treatment adherence.

  3. International study of expert judgment on therapeutic use of benzodiazepines and other psychotherapeutic medications: VI. Trends in recommendations for the pharmacotherapy of anxiety disorders, 1992-1997.

    Science.gov (United States)

    Uhlenhuth, E H; Balter, M B; Ban, T A; Yang, K

    1999-01-01

    To assemble expert clinical experience and judgment regarding the treatment of anxiety disorders in a systematic, quantitative manner, particularly with respect to changes during the preceding five years. A panel of 73 internationally recognized experts in the pharmacotherapy of anxiety and depression was constituted by multistage peer nomination. Sixty-six completed a questionnaire in 1992, and 51 of those completed a follow-up questionnaire in 1997. This report focuses on the experts' responses to questions about therapeutic options relevant to seven vignettes describing typical cases of different anxiety disorders. The preferred initial treatment strategy in 1992 was a combination of medication with a psychological therapy for all vignettes except simple phobia, where a psychological procedure alone was favored. There was little change in 1997, primarily some decrease in the choice of psychological therapy and some increase in the choice of medication for social phobia. Experts recommending a medication in 1992 most often chose as first-line treatment a benzodiazepine anxiolytic (BZ) for panic disorder (PD), generalized anxiety disorder (GAD), simple phobia, and adjustment disorder. They recommended a beta-blocker most often for social phobia and a tricyclic anti-depressant (TCA) for agoraphobia and obsessive-compulsive disorder (OCD). Nearly a fourth chose a combination of medications, usually a TCA plus a BZ. In 1997, the expert panel's most frequent recommendation for agoraphobia, PD, and OCD changed to a specific serotonin reuptake inhibitor (SSRI); and they also recommended these compounds more often for GAD, social phobia, and simple phobia. Fewer experts chose BZs or TCAs. However, in 1997 many again chose a combination of medications, often a BZ plus a SSRI, so that, overall, there was only a small decline in recommendations for BZs. As second-line medications (1997 only), the experts recommended SSRIs most often for most vignettes, but a TCA for PD and

  4. Telepsychiatrists' Medication Treatment Strategies in the Children's Attention-Deficit/Hyperactivity Disorder Telemental Health Treatment Study

    Science.gov (United States)

    Tse, Yuet Juhn; Fesinmeyer, Megan D.; Garcia, Jessica; Myers, Kathleen

    2016-01-01

    Abstract Objective: The purpose of this study was to examine the prescribing strategies that telepsychiatrists used to provide pharmacologic treatment in the Children's Attention-Deficit/Hyperactivity Disorder (ADHD) Telemental Health Treatment Study (CATTS). Methods: CATTS was a randomized controlled trial that demonstrated the superiority of a telehealth service delivery model for the treatment of ADHD with combined pharmacotherapy and behavior training (n=111), compared with management in primary care augmented with a telepsychiatry consultation (n=112). A diagnosis of ADHD was established with the Computerized Diagnostic Interview Schedule for Children (CDISC), and comorbidity for oppositional defiant disorder (ODD) and anxiety disorders (AD) was established using the CDISC and the Child Behavior Checklist. Telepsychiatrists used the Texas Children's Medication Algorithm Project (TCMAP) for ADHD to guide pharmacotherapy and the treat-to-target model to encourage their assertive medication management to a predetermined goal of 50% reduction in ADHD-related symptoms. We assessed whether telepsychiatrists' decision making about making medication changes was associated with baseline ADHD symptom severity, comorbidity, and attainment of the treat-to-target goal. Results: Telepsychiatrists showed high fidelity (91%) to their chosen algorithms in medication management. At the end of the trial, the CATTS intervention showed 46.0% attainment of the treat-to-target goal compared with 13.6% for the augmented primary care condition, and significantly greater attainment of the goal by comorbidity status for the ADHD with one and ADHD with two comorbidities groups. Telepsychiatrists' were more likely to decide to make medication adjustments for youth with higher baseline ADHD severity and the presence of disorders comorbid with ADHD. Multiple mixed methods regression analyses controlling for baseline ADHD severity and comorbidity status indicated that the telepsychiatrists

  5. Utilization of never-medicated bipolar disorder patients towards development and validation of a peripheral biomarker profile.

    Directory of Open Access Journals (Sweden)

    Catherine L Clelland

    Full Text Available There are currently no biological tests that differentiate patients with bipolar disorder (BPD from healthy controls. While there is evidence that peripheral gene expression differences between patients and controls can be utilized as biomarkers for psychiatric illness, it is unclear whether current use or residual effects of antipsychotic and mood stabilizer medication drives much of the differential transcription. We therefore tested whether expression changes in first-episode, never-medicated BPD patients, can contribute to a biological classifier that is less influenced by medication and could potentially form a practicable biomarker assay for BPD. We employed microarray technology to measure global leukocyte gene expression in first-episode (n=3 and currently medicated BPD patients (n=26, and matched healthy controls (n=25. Following an initial feature selection of the microarray data, we developed a cross-validated 10-gene model that was able to correctly predict the diagnostic group of the training sample (26 medicated patients and 12 controls, with 89% sensitivity and 75% specificity (p<0.001. The 10-gene predictor was further explored via testing on an independent cohort consisting of three pairs of monozygotic twins discordant for BPD, plus the original enrichment sample cohort (the three never-medicated BPD patients and 13 matched control subjects, and a sample of experimental replicates (n=34. 83% of the independent test sample was correctly predicted, with a sensitivity of 67% and specificity of 100% (although this result did not reach statistical significance. Additionally, 88% of sample diagnostic classes were classified correctly for both the enrichment (p=0.015 and the replicate samples (p<0.001. We have developed a peripheral gene expression biomarker profile, that can classify healthy controls from patients with BPD receiving antipsychotic or mood stabilizing medication, which has both high sensitivity and specificity

  6. Cultural Biases in Current Medical Practices with a Specific Attention to Orthopedic Surgery: a Review.

    Science.gov (United States)

    Etienne, Gracia; Pierce, Todd P; Khlopas, Anton; Chughtai, Morad; Lavernia, Carlos J; Vogelstein, Teva Y; Thomas, Craig M; Modlin, Charles S; Mont, Michael A

    2017-07-17

    Due to the increasing diversity within the United States population, there is an ever-increasing need for increased education on cultural literacy and tolerance in medical schools and residency programs. The purpose of this article was to review how a person's culture can play a substantive role in effecting and influencing (1) medical diagnosis, (2) patient and health provider medical decision-making, (3) the patient's perception of disease, and (4) the doctor-patient relationships. Many of the decisions we make as orthopedic surgeons must account for the patient's cultural needs, as much of our work impacts patients' daily activities and function. When considering the patient's perception of disease, validated tools have been developed, such as the Patient-Specific Index, which can be used to assess the feelings, goals, and expectations of patients. Cultural competency should be a part of curricula at every level of medical education.

  7. Disorder-specific characteristics of borderline personality disorder with co-occurring depression and its comparison with major depression: An fMRI study with emotional interference task

    OpenAIRE

    Chechko, Natalia; Kellermann, Thilo; Augustin, Marc; Zvyagintsev, Michael; Schneider, Frank; Habel, Ute

    2016-01-01

    Borderline personality disorder (BPD) and major depressive disorder (MDD) are both associated with abnormalities in the regulation of emotion, with BPD being highly comorbid with MDD. Disorder-specific dysfunctions in BPD, however, have hardly been addressed, hence the lack of knowledge pertaining to the specificity of emotion processing deficits and their commonality with MDD. 24 healthy comparison subjects, 21 patients with MDD, and 13 patients with comorbid BPD and MDD (BPD + MDD group)...

  8. Medical Compromise in Eating Disorders Not Otherwise Specified: Are Diagnostic Criteria for Eating Disorders Markers of Severity?

    Science.gov (United States)

    Peebles, Rebecka; Hardy, Kristina K.; Wilson, Jenny L.; Lock, James D.

    2010-01-01

    Objective To compare the medical severity of adolescents with eating disorders not otherwise specified (EDNOS) to those with anorexia nervosa (AN) and bulimia nervosa (BN). Patients and Methods Medical records of 1310 females aged 8 through 19 years treated for AN, BN, or EDNOS were retrospectively reviewed. EDNOS patients were subdivided into partial anorexia (pAN) and partial bulimia (pBN) categories if they met all but one DSM-IV criterion for AN or BN, respectively. Primary outcome variables were heart rate, systolic blood pressure, temperature, and QTc interval on electrocardiogram. Additional physiologically significant medical complications were also reviewed. Results 25.2% had AN, 12.4% BN, and 62.4% had EDNOS. The medical severity of EDNOS patients was intermediate to that of subjects with AN and BN in all primary outcomes. Patients with pAN had significantly higher heart rates, systolic blood pressures, and temperatures than those with AN; patients with pBN did not differ significantly from those with BN in any primary outcome variable; however, subjects with pAN and pBN differed significantly from each other in all outcome variables. Patients with pBN and BN had longer QTc intervals and higher rates of additional medical complications reported at presentation than other groups. Conclusions EDNOS is a medically heterogeneous category with serious physiologic sequelae in children and adolescents. Broadening AN and BN criteria in pediatric patients to include pAN and pBN patients may prove to be clinically useful. PMID:20385643

  9. Female medical students are estimated to have a higher risk for developing eating disorders than male medical students.

    Science.gov (United States)

    Dissing, Agnete Skovlund; Bak, Nanna Hasle; Pedersen, Laura Erna Toftegaard; Petersson, Birgit H

    2011-01-01

    Studies show that university students are at risk for eating disorders. However, risk behaviour has not been studied among Danish medical students, nor have the gender differences in risk behaviour been described in a Danish context. All first-year medical students (n = 979) received a questionnaire related to body perception, exercise habits, eating habits, height and weight in the fall of 2006 and 2007. The response rate was 57% (n = 561). The gender distribution of the study population was 71.8% females and 28.2% males and the average age was 21.5 years. More males (89.8%) than females (73.1%) were satisfied with their body and more females (34.8%) than males (10.9%) felt too fat. More females (42.7%) than males (19.9%) felt guilty when eating unhealthy food. 2.3% (all females) claimed to feel anxiety when they were about to eat. More males (48.4%) than females (28.6%) stated that they could not keep themselves from exercising. 13.5% of the underweight females (body mass index eating disorders than male students. Future research in this area should address the causes of such behaviour.

  10. A Domain Specific Language for Performance Evaluation of Medical Imaging Systems

    NARCIS (Netherlands)

    van den Berg, Freek; Remke, Anne Katharina Ingrid; Haverkort, Boudewijn R.H.M.; Turau, Volker; Kwiatkowska, Marta; Mangharam, Rahul; Weyer, Christoph

    2014-01-01

    We propose iDSL, a domain specific language and toolbox for performance evaluation of Medical Imaging Systems. iDSL provides transformations to MoDeST models, which are in turn converted into UPPAAL and discrete-event MODES models. This enables automated performance evaluation by means of model

  11. Musculoskeletal disorder costs and medical claim filing in the US retail trade sector.

    Science.gov (United States)

    Bhattacharya, Anasua; Leigh, J Paul

    2011-01-01

    The average costs of Musculoskeletal Disorder (MSD) and odds ratios for filing medical claims related to MSD were examined. The medical claims were identified by ICD 9 codes for four US Census regions within retail trade. Large private firms' medical claims data from Thomson Reuters Inc. MarketScan databases for the years 2003 through 2006 were used. Average costs were highest for claims related to lumbar region (ICD 9 Code: 724.02) and number of claims were largest for low back syndrome (ICD 9 Code: 724.2). Whereas the odds of filing an MSD claim did not vary greatly over time, average costs declined over time. The odds of filing claims rose with age and were higher for females and southerners than men and non-southerners. Total estimated national medical costs for MSDs within retail trade were $389 million (2007 USD).

  12. Sensitivity and specificity of proposed DSM-5 diagnostic criteria for autism spectrum disorder.

    Science.gov (United States)

    McPartland, James C; Reichow, Brian; Volkmar, Fred R

    2012-04-01

    This study evaluated the potential impact of proposed DSM-5 diagnostic criteria for autism spectrum disorder (ASD). The study focused on a sample of 933 participants evaluated during the DSM-IV field trial; 657 carried a clinical diagnosis of an ASD, and 276 were diagnosed with a non-autistic disorder. Sensitivity and specificity for proposed DSM-5 diagnostic criteria were evaluated using field trial symptom checklists as follows: individual field trial checklist items (e.g., nonverbal communication); checklist items grouped together as described by a single DSM-5 symptom (e.g., nonverbal and verbal communication); individual DSM-5 criterion (e.g., social-communicative impairment); and overall diagnostic criteria. When applying proposed DSM-5 diagnostic criteria for ASD, 60.6% (95% confidence interval: 57%-64%) of cases with a clinical diagnosis of an ASD met revised DSM-5 diagnostic criteria for ASD. Overall specificity was high, with 94.9% (95% confidence interval: 92%-97%) of individuals accurately excluded from the spectrum. Sensitivity varied by diagnostic subgroup (autistic disorder = 0.76; Asperger's disorder = 0.25; pervasive developmental disorder-not otherwise specified = 0.28) and cognitive ability (IQ criteria could substantially alter the composition of the autism spectrum. Revised criteria improve specificity but exclude a substantial portion of cognitively able individuals and those with ASDs other than autistic disorder. A more stringent diagnostic rubric holds significant public health ramifications regarding service eligibility and compatibility of historical and future research. Copyright © 2012 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

  13. Are there specific metacognitive processes associated with anxiety disorders in youth?

    Directory of Open Access Journals (Sweden)

    Terri Landon Bacow

    2010-09-01

    Full Text Available Terri Landon Bacow1, Jill Ehrenreich May2, Leslie R Brody3, Donna B Pincus41Mount Sinai School of Medicine, New York City, NY, USA; 2Department of Psychology, University of Miami, FL, USA; 3Department of Psychology, 4Center for Anxiety and Related Disorders, Boston University, MA, USAAbstract: While Wells’ metacognitive model of generalized anxiety disorder (GAD posits that certain metacognitive processes, such as negative meta-worry (negative beliefs about worry, are more strongly associated with symptoms of GAD than other anxiety disorders in adults, research has yet to determine whether the same pattern is true for younger individuals. We examined the relationship between several metacognitive processes and anxiety disorder diagnostic status in a sample of 98 youth aged 7–17 years. Twenty youth with GAD were compared with similarly sized groups of youth with obsessive-compulsive disorder (OCD, n = 18, social phobia (SOC, n = 20, separation anxiety disorder (SAD, n = 20, and healthy controls who were not patients (NONP, n = 20 using a self-report measure of metacognition adapted for use with young people in this age range (Metacognitions Questionnaire for Children. Contrary to expectations, only one specific metacognitive process was significantly associated with an anxiety disorder diagnosis, in that the controls endorsed a greater degree of cognitive monitoring (self-reported awareness of one’s thoughts than those with SAD. In addition, there was a trend indicating that nonpatients scored higher than youth with GAD on this scale. These surprising results suggest potentially differing patterns in the relationships between symptoms and metacognitive awareness in anxious youth, depending on the type of anxiety disorder presentation.Keywords: metacognition, childhood, adolescence, anxiety, diagnosis

  14. Transdiagnostic versus disorder-specific and clinician-guided versus self-guided internet-delivered treatment for Social Anxiety Disorder and comorbid disorders: A randomized controlled trial.

    Science.gov (United States)

    Dear, B F; Staples, L G; Terides, M D; Fogliati, V J; Sheehan, J; Johnston, L; Kayrouz, R; Dear, R; McEvoy, P M; Titov, N

    2016-08-01

    Disorder-specific (DS-CBT) and transdiagnostic (TD-CBT) cognitive behaviour therapy have both been used to treat social anxiety disorder (SAD). This study compared internet-delivered DS-CBT and TD-CBT for SAD across clinician-guided (CG-CBT) and self-guided (SG-CBT) formats. Participants with SAD (n=233) were randomly allocated to receive internet-delivered TD-CBT or DS-CBT and CG-CBT or SG-CBT. Large reductions in symptoms of SAD (Cohen's d≥1.01; avg. reduction≥30%) and moderate-to-large reductions in symptoms of comorbid depression (Cohen's d≥1.25; avg. reduction≥39%), generalised anxiety disorder (Cohen's d≥0.86; avg. reduction≥36%) and panic disorder (Cohen's d≥0.53; avg. reduction≥25%) were found immediately post-treatment and were maintained or further improved to 24-month follow-up. No marked differences were observed between TD-CBT and DS-CBT or CG-CBT and SG-CBT highlighting the potential of each for the treatment of SAD and comorbid disorders. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  15. Enhanced Assessment Technology and Neurocognitive Aspects of Specific Learning Disorder with Impairment in Mathematics.

    Directory of Open Access Journals (Sweden)

    Marios A. Pappas

    2018-02-01

    Full Text Available Specific Learning Disorder with impairment in Mathematics (Developmental Dyscalculia is a complex learning disorder which affects arithmetic skills, symbolic magnitude processing, alertness, flexibility in problem solving and maintained attention. Neuro-cognitive studies revealed that such difficulties in children with DD could be related to poor Working Memory and attention deficits. Furthermore, neuroimaging studies indicate that brain structure differences in children with DD compared to typically developing children could affect mathematical performance. In this study we present the cognitive profile of Dyscalculia, as well as the neuropsychological aspects of the deficit, with special reference to the utilization of enhanced assessment technology such as computerized neuropsychological tools and neuroimaging techniques.

  16. [Analysis of Applying Chinese Medical Clinical Pathway for Treating Attention-deficit Hyperactivity Disorder].

    Science.gov (United States)

    Guo, Yu-qing; Han, Xin-min; Zhu, Xian-kang; Zhou, Zheng; Ma, Bing-xiang; Zhang, Bao-qing; Li, Yan-ning; Feng, Yu-lin; Xue, Zheng; Wang, Yong-hong; Li, Yi-min; Jiang, Zhi-mei; Xu, Jin-xing; Yue, Wei-zhen; Xiang, Xi-xiong

    2015-12-01

    To evaluate the application effect of Chinese medical clinical pathway for treating attention-deficit hyperactivity disorder (ADHD), and to provide evidence for further improving clinical pathways. Totally 270 ADHD children patients were recruited and treated at pediatrics clinics of 9 cooperative hospitals from December 2011 to December 2012. The treatment course for all was 3 months. Scores of attention deficit and hyperactivity rating scale, scores of behavior, Conners index of hyperactivity (CIH), and Chinese medical syndrome scores were compared between before and after treatment. The efficacy difference in various sexes, ages, and disease courses were evaluated by judging standards for Chinese medical syndrome and ADHD. Fifteen children patients who entered clinical pathway dropped out, and the rest 255 completed this trial. Compared with before treatment, total scores of attention deficit and hyperactivity rating scale, scores of attention deficit and hyperactivity rating scale, CIH, and Chinese medical syndrome scores obviously decreased (all P < 0.01). The total effective rate in disease efficacy was 87.8% (224/255 cases), and the total effective rate in Chinese medical syndrome curative effect was 87.5% (223/255 cases). The clinical curative effect was not influenced by age, gender, or course of disease when statistically analyzed from judging standards for Chinese medical syndrome or for disease efficacy. Intervention by Chinese medical clinical pathway could improve ADHD patients' symptoms, and its efficacy was not influenced by sex, age, or course of disease.

  17. Prevalence of Sleep Disorder among Medical Students in an Eastern University in Iran

    OpenAIRE

    Mohsen Heidari Mokarrar; Aboozar Afsharmanesh; Mahdi Afshari; Fatemeh Mohammadi

    2017-01-01

    Background: Sleep disorder is mostly an early manifestation of psychological diseases. It is defined as disturbances in the regularity, quality and quantity of sleep as well as daily activity. Methods: In this cross-sectional study, 200 medical students were assessed for sleep status using SHQ and GHQ questionnaires. Data analysis was carried out using descriptive statistics (mean, standard deviation, frequency) and Chi square test through the statistical package of SPSS V.16. Resul...

  18. The modern trends of forming internet additional disorder between students of medical university

    OpenAIRE

    Vanyushina E.; Goncharova M.

    2017-01-01

    Today the so-called internet–space occupies the special place in our world. The Internet is applying in almost all spheres of human life. That’s why there were manifested different side effects, in particular, the “Internet Additional Disorder”. This paper examines current trends and features of excessive internet–using by students of a medical university as a group of people, who has a predisposition to incipience of Internet Additional Disorder. During research, we interviewed 100 students ...

  19. A review of medications used in the treatment of attention deficit hyperactivity disorder

    Directory of Open Access Journals (Sweden)

    Matej Štuhec

    2013-04-01

    Full Text Available Attention deficit hyperactivity disorder (ADHD is one of the most common developmental disorders in children and adolescents with core symptoms of hyperactivity, impulsivity andinattention. Atomoxetine, immediate-release methylphenidate and extended release methylphenidate are approved for use in patients with ADHD in Slovenia. In addition, ADHD is also treated off-label with bupropion, tricyclic antidepressants and some other drugs. According to the recently adopted American and European guidelines, pharmacotherapy includes the initial, maintenance and terminal phase. Consideration of pharmacokinetic parameters of the selected drugs and potential drug-drug interactions, if the patient is taking other medications, helps to reduce symptoms of ADHD, and improves the selection of drug and appropriate dosing regimen. Clinical outcomes should be measured by standardised questionnaires. The drug of choice is methylphenidate. Guidelines for the treatment of ADHD should also include recommendations on psychosocial treatments and destigmatization of patients with this disorder. In this paper, pharmacotherapy guidelines for patients with ADHD are highlighted.

  20. Medical student perspective: working toward specific and actionable clinical clerkship feedback.

    Science.gov (United States)

    Moss, Haley A; Derman, Peter B; Clement, R Carter

    2012-01-01

    Feedback on the wards is an important component of medical student education. Medical schools have incorporated formalized feedback mechanisms such as clinical encounter cards and standardized patient encounters into clinical curricula. However, the system could be further improved as medical students frequently feel uncomfortable requesting feedback, and are often dissatisfied with the quality of the feedback they receive. This article explores the shortcomings of the existing medical student feedback system and examines the relevant literature in an effort to shed light on areas in which the system can be enhanced. The discussion focuses on resident-provided feedback but is broadly applicable to delivering feedback in general. A review of the organizational psychology and business administration literature on fostering effective feedback was performed. These insights were then applied to the setting of medical education. Providing effective feedback requires training and forethought. Feedback itself should be specific and actionable. Utilizing these strategies will help medical students and educators get the most out of existing feedback systems.

  1. Comorbidity of obsessive-compulsive disorder with obsessive-compulsive personality disorder: Does it imply a specific subtype of obsessive-compulsive disorder?

    Science.gov (United States)

    Garyfallos, George; Katsigiannopoulos, Konstantinos; Adamopoulou, Aravela; Papazisis, Georgios; Karastergiou, Anastasia; Bozikas, Vasilios P

    2010-05-15

    The present study examined whether the comorbidity of obsessive-compulsive personality disorder (OCPD) and obsessive-compulsive disorder (OCD) constitute a specific subtype of OCD. The study sample consisted of 146 consecutive outpatients with a DSM-IV diagnosis of OCD. Diagnoses were established using MINI, IPDE, YBOCS and YBOCS-SC. OCD patients with comorbid OCPD were compared with OCD patients without OCPD on various sociodemographic and clinical variables. Almost one third of the OCD subjects met criteria for comorbid OCPD. OCD+OCPD patients had a significantly earlier age at onset of initial OC symptoms, earlier age at onset of OCD and more obsessions and compulsions than pure obsessions compared to the patients with OCDOCPD. OCD+OCPD patients also had a higher rate of comorbidity with avoidant personality disorder and showed more impairment in global functioning. There were not differences between the two sub-groups on severity of OCD symptoms and also on type of OCD onset. Our results indicate that the comorbidity of OCD with OCPD is associated with a number of specific clinical characteristics of OCD. These findings in conjunction with of current clinical, family and genetic studies provide some initial evidence that OCD comorbid with OCPD constitute a specific subtype of OCD. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

  2. US Adult Illicit Cannabis Use, Cannabis Use Disorder, and Medical Marijuana Laws: 1991-1992 to 2012-2013.

    Science.gov (United States)

    Hasin, Deborah S; Sarvet, Aaron L; Cerdá, Magdalena; Keyes, Katherine M; Stohl, Malka; Galea, Sandro; Wall, Melanie M

    2017-06-01

    significantly greater in late-MML states (1.6-percentage point more; SE, 0.6; P = .01), California (1.8-percentage point more; SE, 0.9; P = .04), and Colorado (3.5-percentage point more; SE, 1.5; P = .03). Increases in cannabis use disorder, which was less prevalent, were smaller but followed similar patterns descriptively, with change greater than never-MML states in California (1.0-percentage point more; SE, 0.5; P = .06) and Colorado (1.6-percentage point more; SE, 0.8; P = .04). Medical marijuana laws appear to have contributed to increased prevalence of illicit cannabis use and cannabis use disorders. State-specific policy changes may also have played a role. While medical marijuana may help some, cannabis-related health consequences associated with changes in state marijuana laws should receive consideration by health care professionals and the public.

  3. Sensitivity and specificity of the mood disorder questionnaire and the bipolar spectrum diagnostic scale in Argentinean patients with mood disorders.

    Science.gov (United States)

    Zaratiegui, Rodolfo M; Vázquez, Gustavo H; Lorenzo, Laura S; Marinelli, Marcia; Aguayo, Silvia; Strejilevich, Sergio A; Padilla, Eduardo; Goldchluk, Aníbal; Herbst, Luis; Vilapriño, Juan J; Bonetto, Gerardo García; Cetkovich-Bakmas, Marcelo G; Abraham, Estela; Kahn, Clara; Whitham, Elizabeth A; Holtzman, Niki S; Ghaemi, Nassir

    2011-08-01

    To assess the sensitivity and specificity of two self-report instruments for detection of bipolarity in a sample of Argentinean patients. Spanish versions of the MDQ and the BSDS were administered over four months at 11 sites in Argentina. Diagnoses were made using DSM-IV criteria and the MINI. The study sample consisted of patients diagnosed with Bipolar Disorder (BD) Types I, II, or NOS. BDNOS diagnoses were made using extended guidelines for bipolar spectrum symptoms. Unipolar patients were used as a control group. Of 493 patients screened, 354 completed evaluation by MDQ and MINI, and 363 by BSDS and MINI. Specificity of MDQ was 0.97 and BSDS was 0.81. MDQ sensitivity was 0.70 for bipolar type I (BD-I), 0.52 for bipolar II (BD-II) and 0.31 for bipolar not otherwise specified (BDNOS). BSDS sensitivities were 0.75, 0.70 and 0.51 respectively. This study was performed in specialized outpatient settings and thus its results are not necessarily representative for other clinical settings. There was not a systematic evaluation of comorbid psychiatric disease or test-retest reliability. The local versions of the MDQ and the BSDS showed a sensitivity and specificity comparable to previous research. Our results indicate that in this sample, MDQ was more specific for BD and BSDS was more sensitive to detect BD-II and NOS. Since BD-I is more readily recognized than bipolar spectrum disorders, enhanced sensitivity of BSDS for soft bipolarity may be an advantage. Copyright © 2011 Elsevier B.V. All rights reserved.

  4. Vineland-II adaptive behavior profile of children with attention-deficit/hyperactivity disorder or specific learning disorders.

    Science.gov (United States)

    Balboni, Giulia; Incognito, Oriana; Belacchi, Carmen; Bonichini, Sabrina; Cubelli, Roberto

    2017-02-01

    The evaluation of adaptive behavior is informative in children with attention-deficit/hyperactivity disorder (ADHD) or specific learning disorders (SLD). However, the few investigations available have focused only on the gross level of domains of adaptive behavior. To investigate which item subsets of the Vineland-II can discriminate children with ADHD or SLD from peers with typical development. Student's t-tests, ROC analysis, logistic regression, and linear discriminant function analysis were used to compare 24 children with ADHD, 61 elementary students with SLD, and controls matched on age, sex, school level attended, and both parents' education level. Several item subsets that address not only ADHD core symptoms, but also understanding in social context and development of interpersonal relationships, allowed discrimination of children with ADHD from controls. The combination of four item subsets (Listening and attending, Expressing complex ideas, Social communication, and Following instructions) classified children with ADHD with both sensitivity and specificity of 87.5%. Only Reading skills, Writing skills, and Time and dates discriminated children with SLD from controls. Evaluation of Vineland-II scores at the level of item content categories is a useful procedure for an efficient clinical description. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. Medical image of the week: REM sleep behavior disorder in Parkinson disease

    Directory of Open Access Journals (Sweden)

    Nahapetian RR

    2014-06-01

    Full Text Available No abstract available. Article truncated after first 150 words. A 55 year old female with a past medical history significant for Parkinson disease status-post implantation of bilateral deep brain stimulators, depression, and restless legs syndrome, who initially presented to the sleep clinic on referral by neurology for evaluation of disordered sleep. Medications included carbidopa-levodopa, escitalopram, gabapentin, lorazepam, ambien, and pramipexole. Her subjective sleep complaints included snoring, restless sleep, difficulty in maintaining sleep, sleep related anxiety, dream enactment behavior, nightmares, and sleep talking. She was sent to the sleep laboratory for evaluation of suspected rapid eye movement behavior disorder (RBD. Overnight polysomnogram did not show evidence for sleep disordered breathing. The sleep study was notable for rapid eye movement (REM sleep without atonia, visible arm and leg movements, and audible moaning, speaking, and crying out. These findings corroborated the subjective complaints expressed by the patient and her husband. Her medication regimen was altered. Zolpidem and lorazepam were discontinued and she ...

  6. Pros and Cons of Medical Cannabis use by People with Chronic Brain Disorders

    Science.gov (United States)

    Suryadevara, Uma; Bruijnzeel, Dawn M.; Nuthi, Meena; Jagnarine, Darin A.; Tandon, Rajiv; Bruijnzeel, Adriaan W.

    2017-01-01

    Background: Cannabis is the most widely used illicit drug in the world and there is growing concern about the mental health effects of cannabis use. These concerns are at least partly due to the strong increase in recreational and medical cannabis use and the rise in tetrahydrocannabinol (THC) levels. Cannabis is widely used to self-medicate by older people and people with brain disorders such as amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), Alzheimer’s disease (AD), Parkinson’s disease (PD), bipolar disorder, and schizophrenia. Objective: This review provides an overview of the perceived benefits and adverse mental health effects of cannabis use in people with ALS, MS, AD, PD, bipolar disorder, and schizophrenia. Results: The reviewed studies indicate that cannabis use diminishes some symptoms associated with these disorders. Cannabis use decreases pain and spasticity in people with MS, decreases tremor, rigidity, and pain in people with PD, and improves the quality of life of ALS patients by improving appetite, and decreasing pain and spasticity. Cannabis use is more common among people with schizophrenia than healthy controls. Cannabis use is a risk factor for schizophrenia which increases positive symptoms in schizophrenia patients and diminishes negative symptoms. Cannabis use worsens bipolar disorder and there is no evidence that bipolar patients derive any benefit from cannabis. In late stage Alzheimer’s patients, cannabis products may improve food intake, sleep quality, and diminish agitation. Conclusion: Cannabis use diminishes some of the adverse effects of neurological and psychiatric disorders. However, chronic cannabis use may lead to cognitive impairments and dependence. PMID:27804883

  7. A Naturalistic Comparison of Group Transdiagnostic Behaviour Therapy (TBT) and Disorder-Specific Cognitive Behavioural Therapy Groups for the Affective Disorders.

    Science.gov (United States)

    Gros, Daniel F; Merrifield, Colleen; Rowa, Karen; Szafranski, Derek D; Young, Lisa; McCabe, Randi E

    2018-05-29

    Transdiagnostic psychotherapies are designed to apply the same underlying treatment principles across a set of psychiatric disorders, without significant tailoring to specific diagnoses. Several transdiagnostic psychotherapy protocols have been developed recently, each of which has its own strengths and weaknesses. One promising treatment is Transdiagnostic Behaviour Therapy (TBT), in that it is one of the few transdiagnostic treatments to date shown to be effective in patients with depressive and anxiety disorders. However, TBT has only been investigated via individual psychotherapy. The present study investigated the effectiveness of a group protocol for TBT, compared with disorder-specific group psychotherapies, in a naturalistic setting. 109 participants with various diagnoses of affective disorders completed either group TBT (n = 37) or a disorder-specific group psychotherapy (n = 72). Measures included assessments of psychiatric symptomatology and transdiagnostic impairment at baseline and post-treatment. Overall, participants in the TBT group demonstrated significant improvements across all measures. When compared with disorder-specific groups, no statistical differences were observed between groups across symptoms; however, participants in the TBT group demonstrated roughly twice the treatment effect sizes in transdiagnostic impairment compared with participants in the disorder-specific groups. In addition, when participants from the most well-represented diagnosis and disorder-specific treatment (social anxiety disorder) were investigated separately, participants in the TBT group demonstrated significantly larger improvements in comorbid depressive symptoms than participants in the disorder-specific treatment. Pending replication and additional comparison studies, group TBT may provide an effective group treatment option for patients with affective disorders.

  8. Symptom-specific amygdala hyperactivity modulates motor control network in conversion disorder

    Directory of Open Access Journals (Sweden)

    Thomas Hassa

    2017-01-01

    Full Text Available Initial historical accounts as well as recent data suggest that emotion processing is dysfunctional in conversion disorder patients and that this alteration may be the pathomechanistic neurocognitive basis for symptoms in conversion disorder. However, to date evidence of direct interaction of altered negative emotion processing with motor control networks in conversion disorder is still lacking. To specifically study the neural correlates of emotion processing interacting with motor networks we used a task combining emotional and sensorimotor stimuli both separately as well as simultaneously during functional magnetic resonance imaging in a well characterized group of 13 conversion disorder patients with functional hemiparesis and 19 demographically matched healthy controls. We performed voxelwise statistical parametrical mapping for a priori regions of interest within emotion processing and motor control networks. Psychophysiological interaction (PPI was used to test altered functional connectivity of emotion and motor control networks. Only during simultaneous emotional stimulation and passive movement of the affected hand patients displayed left amygdala hyperactivity. PPI revealed increased functional connectivity in patients between the left amygdala and the (pre-supplemental motor area and the subthalamic nucleus, key regions within the motor control network. These findings suggest a novel mechanistic direct link between dysregulated emotion processing and motor control circuitry in conversion disorder.

  9. Symptom-specific amygdala hyperactivity modulates motor control network in conversion disorder.

    Science.gov (United States)

    Hassa, Thomas; Sebastian, Alexandra; Liepert, Joachim; Weiller, Cornelius; Schmidt, Roger; Tüscher, Oliver

    2017-01-01

    Initial historical accounts as well as recent data suggest that emotion processing is dysfunctional in conversion disorder patients and that this alteration may be the pathomechanistic neurocognitive basis for symptoms in conversion disorder. However, to date evidence of direct interaction of altered negative emotion processing with motor control networks in conversion disorder is still lacking. To specifically study the neural correlates of emotion processing interacting with motor networks we used a task combining emotional and sensorimotor stimuli both separately as well as simultaneously during functional magnetic resonance imaging in a well characterized group of 13 conversion disorder patients with functional hemiparesis and 19 demographically matched healthy controls. We performed voxelwise statistical parametrical mapping for a priori regions of interest within emotion processing and motor control networks. Psychophysiological interaction (PPI) was used to test altered functional connectivity of emotion and motor control networks. Only during simultaneous emotional stimulation and passive movement of the affected hand patients displayed left amygdala hyperactivity. PPI revealed increased functional connectivity in patients between the left amygdala and the (pre-)supplemental motor area and the subthalamic nucleus, key regions within the motor control network. These findings suggest a novel mechanistic direct link between dysregulated emotion processing and motor control circuitry in conversion disorder.

  10. Residual symptoms and specific functional impairments in euthymic patients with bipolar disorder.

    Science.gov (United States)

    Samalin, Ludovic; de Chazeron, Ingrid; Vieta, Eduard; Bellivier, Frank; Llorca, Pierre-Michel

    2016-03-01

    The aims of the present study were to confirm the impact of residual symptoms on overall functioning in a large sample of euthymic patients with bipolar disorder in real-life conditions and to explore the relationship between residual symptoms and specific areas of functional impairment. This was a multicenter, cross-sectional, non-interventional study of euthymic outpatients with bipolar disorder. The Functioning Assessment Short Test was used to assess overall and specific domains of functioning (autonomy, occupational functioning, cognitive functioning, financial issues, interpersonal relationships, and leisure time). Various residual symptoms were assessed (residual mood symptoms, emotional dysregulation, sleep and sexual disorders, stigma, and perceived cognitive impairment). Logistic regression was used to determine the best model of association between functional domains and residual symptoms. Almost half of the 468 patients included (42%) had poor overall functioning. Residual depressive symptoms appeared to have an impact on overall functioning and in nearly all areas of functioning. In addition, specific residual symptoms had significantly more negative effects on some domains of functioning in euthymic patients with bipolar disorder (residual manic symptoms and occupational stigma on autonomy, emotional inhibition on occupational functioning, residual manic symptoms on financial issues, family stigma on interpersonal relationships, and sexual function and occupational stigma on leisure time). Our findings highlight the importance of evaluating overall functioning in clinical practice as well as functional domains. They also indicate that some residuals symptoms in patients with bipolar disorder should be targeted in personalized treatment plans, in order to improve functioning in the domains in which the patient is most impaired. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  11. Women-specific mental disorders in DSM-V: are we failing again?

    Science.gov (United States)

    Wittchen, Hans-Ulrich

    2010-02-01

    Despite a wealth of studies on differences regarding the biobehavioral and social-psychological bases of mental disorders in men and women and repeated calls for increased attention, women-specific issues have so far not been comprehensively addressed in past diagnostic classification systems of mental disorders. There is also increasing evidence that this situation will not change significantly in the upcoming revisions of ICD-11 and DSM-V. This paper explores reasons for this continued failure, highlighting three major barriers: the fragmentation of the field of women's mental health research, lack of emphasis on diagnostic classificatory issues beyond a few selected clinical conditions, and finally, the "current rules of game" used by the current DSM-V Task Forces in the revision process of DSM-V. The paper calls for concerted efforts of researchers, clinicians, and other stakeholders within a more coherent and comprehensive framework aiming at broader coverage of women-specific diagnostic classificatory issues in future diagnostic systems.

  12. [Disease versus disorder. Medical and socio-environmental aspects of mental suffering].

    Science.gov (United States)

    Heinz, A

    2015-01-01

    A disease concept should be broad enough to provide social protection for all subjects suffering from this malady but at the same time it needs to be narrow enough to avoid pathologization of behavior that is merely socially undesirable. From a medical perspective a"disease" is present if functions are impaired that are relevant for individual survival. In the field of psychiatry and psychotherapy, such medically relevant functions include the ability to be alert and fully oriented, to ascribe one's own intentions to oneself and to modulate affects according to the situation. Beyond such medically relevant symptoms of a disease, any clinically relevant dysfunction should also be harmful for the individual if a mental malady is to be diagnosed. One such harmful consequence of a disease can be that the person feels ill and suffers from this state, another negative consequence for the individual can be due to an impairment of activities of daily living and social participation. These harmful consequences of a disease are usually discussed under the heading of the"illness experience" and the"sickness aspect" of any disorder. Beyond mental maladies characterized by disease symptoms that are accompanied either by an illness experience or impaired activities of daily living and social participation (sickness), there are many states of human suffering which can be objectified and classified but do not constitute a disease in the medical sense and should more aptly be named a disorder.

  13. Premenstrual dysphoric disorder in medical students residing in hostel and its association with lifestyle factors

    Directory of Open Access Journals (Sweden)

    Amrita Mishra

    2015-01-01

    Full Text Available Context: There is scant research on premenstrual syndrome (PMS and its more severe counterpart, premenstrual dysphoric disorder (PMDD in Indian females. This study aimed to evaluate symptoms of PMS in medical students and to find the association of sociodemographic variables and lifestyle factors with PMDD. Subjects and Methods: A total of 179 medical students residing in the hostel of an Indian medical college and its affiliated teaching hospital were approached, of which 100 (55.8% returned the completed questionnaires. Data related to lifestyle factors was collected. Self-screening quiz for Diagnostic and Statistical Manual of Mental Disorders-IV-Text Revision PMDD and Shortened Premenstrual Assessment Form were used for diagnosis of PMDD and detection of symptomatology, respectively. Results: PMDD was present in 37% of the respondents. It was found at a higher rate in older and postgraduate students. PMDD was significantly associated with lifestyle factors, namely, sleep, physical activity, total tea/coffee intake, and change in tea/coffee and food intake under stress. The most common physical and psychological symptoms were body ache/joint pain and feeling depressed/blue, respectively. Conclusions: PMDD is fairly common in Indian medical students residing in hostel although cultural factors may influence symptom expression. This study suggests that PMDD is associated with lifestyle factors in young, professional, urban women. Modification in lifestyle may thus be an important approach for management of PMS/PMDD. Prospective studies with larger representative samples are needed to validate these findings.

  14. Premenstrual dysphoric disorder in medical students residing in hostel and its association with lifestyle factors.

    Science.gov (United States)

    Mishra, Amrita; Banwari, Girish; Yadav, Priyanka

    2015-01-01

    There is scant research on premenstrual syndrome (PMS) and its more severe counterpart, premenstrual dysphoric disorder (PMDD) in Indian females. This study aimed to evaluate symptoms of PMS in medical students and to find the association of sociodemographic variables and lifestyle factors with PMDD. A total of 179 medical students residing in the hostel of an Indian medical college and its affiliated teaching hospital were approached, of which 100 (55.8%) returned the completed questionnaires. Data related to lifestyle factors was collected. Self-screening quiz for Diagnostic and Statistical Manual of Mental Disorders-IV-Text Revision PMDD and Shortened Premenstrual Assessment Form were used for diagnosis of PMDD and detection of symptomatology, respectively. PMDD was present in 37% of the respondents. It was found at a higher rate in older and postgraduate students. PMDD was significantly associated with lifestyle factors, namely, sleep, physical activity, total tea/coffee intake, and change in tea/coffee and food intake under stress. The most common physical and psychological symptoms were body ache/joint pain and feeling depressed/blue, respectively. PMDD is fairly common in Indian medical students residing in hostel although cultural factors may influence symptom expression. This study suggests that PMDD is associated with lifestyle factors in young, professional, urban women. Modification in lifestyle may thus be an important approach for management of PMS/PMDD. Prospective studies with larger representative samples are needed to validate these findings.

  15. Identification of neuromotor deficits common to autism spectrum disorder and attention deficit/hyperactivity disorder, and imitation deficits specific to autism spectrum disorder.

    Science.gov (United States)

    Biscaldi, Monica; Rauh, Reinhold; Müller, Cora; Irion, Lisa; Saville, Christopher W N; Schulz, Eberhard; Klein, Christoph

    2015-12-01

    Deficits in motor and imitation abilities are a core finding in autism spectrum disorders (ASD), but impaired motor functions are also found in attention deficit/hyperactivity disorder (ADHD). Given recent theorising about potential aetiological overlap between the two disorders, the present study aimed to assess difficulties in motor performance and imitation of facial movements and meaningless gestures in a sample of 24 ADHD patients, 22 patients with ASD, and 20 typically developing children, matched for age (6-13 years) and similar in IQ (>80). Furthermore, we explored the impact of comorbid ADHD symptoms on motor and imitation performance in the ASD sample and the interrelationships between the two groups of variables in the clinical groups separately. The results show motor dysfunction was common to both disorders, but imitation deficits were specific to ASD. Together with the pattern of interrelated motor and imitation abilities, which we found exclusively in the ASD group, our findings suggest complex phenotypic, and possibly aetiological, relationships between the two neurodevelopmental conditions.

  16. Allostatic load but not medical burden predicts memory performance in late-life bipolar disorder.

    Science.gov (United States)

    Vaccarino, Sophie R; Rajji, Tarek K; Gildengers, Ariel G; Waters, Sarah E S; Butters, Meryl A; Menon, Mahesh; Blumberger, Daniel M; Voineskos, Aristotle N; Miranda, Dielle; Mulsant, Benoit H

    2018-03-01

    Older patients with bipolar disorder (BD) present with variable degrees of cognitive impairment. Over time, stress, mood episodes, and comorbidities increase the body's allostatic load. We assessed the extent to which allostatic load vs more traditional measures of medical burden account for the heterogeneity in cognition in this population. Thirty-five older euthymic patients with BD and 30 age-equated, gender-equated, and education-equated comparison participants were administered a comprehensive assessment including a neuropsychological battery, and 9 physiological measures to determine allostatic load. The relationship among allostatic load, medical burden, and cognition was assessed. Compared with the mentally healthy comparators, patients were impaired globally, and in 4 cognitive domains-information-processing speed / executive functioning, delayed memory, language, and visuomotor ability, and presented with greater medical burden but not a different allostatic load. Allostatic load, but not medical burden, was associated with delayed memory performance both in a correlational analysis and in a multivariate regression analysis. Euthymic older patients with BD are impaired on several cognitive domains and have high medical burden. Their memory performance is more strongly associated with allostatic load than with traditional measures of medical burden. These findings need to be replicated and extended longitudinally. Copyright © 2017 John Wiley & Sons, Ltd.

  17. 78 FR 7659 - Revised Medical Criteria for Evaluating Congenital Disorders That Affect Multiple Body Systems

    Science.gov (United States)

    2013-02-04

    .... People with non- mosaic Down syndrome may also have congenital heart disease, impaired vision, hearing..., or interference, as well as the resulting functional limitations and their progression, may vary... senses and speech, neurological, or mental disorders. Otherwise, we evaluate the specific functional...

  18. Pathological motivations for exercise and eating disorder specific health-related quality of life.

    Science.gov (United States)

    Cook, Brian; Engel, Scott; Crosby, Ross; Hausenblas, Heather; Wonderlich, Stephen; Mitchell, James

    2014-04-01

    To examine associations among pathological motivations for exercise with eating disorder (ED) specific health-related quality of life (HRQOL). Survey data assessing ED severity (i.e., Eating Disorder Diagnostic Survey), ED specific HRQOL (i.e., Eating Disorders Quality of Life Instrument), and pathological motivations for exercise (i.e., Exercise Dependence Scale) were collected from female students (N = 387) at seven universities throughout the United States. Regression analyses were conducted to examine the associations among exercise dependence, ED-specific HRQOL and ED severity, and the interaction of exercise dependence and ED severity on HRQOL scores. The overall model examining the impact of ED severity and exercise dependence (independent variables) on HRQOL (dependent variable) was significant and explained 16.1% of the variance in HRQOL scores. Additionally, the main effects for ED severity and exercise dependence and the interaction among ED severity and exercise dependence were significant, suggesting that the combined effects of ED severity and exercise dependence significantly impacts HRQOL. Our results suggest that pathological motivations for exercise may exacerbate ED's detrimental impact on HRQOL. Our results offer one possible insight into why exercise may be associated with deleterious effects on ED HRQOL. Future research is needed to elucidate the relationship among psychological aspects of exercise, ED, and HRQOL. Copyright © 2013 Wiley Periodicals, Inc.

  19. Perceptions of the state policy environment and adoption of medications in the treatment of substance use disorders.

    Science.gov (United States)

    Knudsen, Hannah K; Abraham, Amanda J

    2012-01-01

    Despite growing interest in the use of evidence-based treatment practices for treating substance use disorders, adoption of medications by treatment programs remains modest. Drawing on resource dependence and institutional theory, this study examined the relationships between adoption of medications by treatment programs and their perceptions about the state policy environment. Data were collected through mailed surveys and telephone interviews with 250 administrators of publicly funded substance abuse treatment programs in the United States between 2009 and 2010. Multiple imputation and multivariate logistic regression were used to estimate the associations between perceptions of the state policy environment and the odds of adopting at least one medication for the treatment of substance use disorders. A total of 91 (37%) programs reported having prescribed any medication for treatment of a substance use disorder. Programs were significantly more likely to have adopted at least one medication if they perceived greater support for medications by the Single State Agency. The odds of adoption were significantly greater if the program was aware that at least one medication was included on their state's Medicaid formulary and that state-contract funding permitted the purchase of medications. States may play significant roles in promoting the adoption of medications, but adequate dissemination of information about state policies and priorities may be vital to further adoption. Future research should continue to study the relationships between the adoption of medications for treating substance use disorders and the evolving policy environment.

  20. Moving Beyond the Theoretical: Medical Students' Desire for Practical, Role-Specific Ethics Training.

    Science.gov (United States)

    Stites, Shana D; Clapp, Justin; Gallagher, Stefanie; Fiester, Autumn

    2018-05-04

    Background It has been widely reported that medical trainees experience situations with profound ethical implications during their clinical rotations. To address this most U.S. medical schools include ethics curricula in their undergraduate programs. However, the content of these curricula vary substantially. Our pilot study aimed to discover, from the students' perspective, how ethics pedagogy prepares medical students for clerkship and what gaps might remain. This qualitative study organized focus groups of third- and fourth-year medical students. Participants recounted ethical concerns encountered during clerkship rotations and reflected on how their medical school ethics curriculum informed their responses to these scenarios. Transcripts of the focus group sessions were analyzed using a grounded theory approach to identify common themes that characterized the students' experiences. While students' accounts demonstrated a solid grasp of ethical theory and attunement to ethical concerns presented in the clinic, they also consistently evinced an inability to act on these issues given clerks' particular position in a complex learning hierarchy. Students felt they received too little training in the role-specific application of medical ethics as clinical trainees. We found a desire among trainees for enhanced practical ethics training in preparation for the clerkship phase of medical education. We recommend several strategies that can begin to address these findings. The use of roleplaying with standardized patients can enable students to practice engagement with ethical issues. Conventional ethics courses can focus more on action-based pedagogy and instruction in conflict management techniques. Finally, clear structures for reporting and seeking advice and support for addressing ethical issues can lessen students' apprehension to act on ethical concerns.

  1. How we created a peer-designed specialty-specific selective for medical student career exploration.

    Science.gov (United States)

    Keating, Elizabeth M; O'Donnell, Erin P; Starr, Stephanie R

    2013-01-01

    In recent years, medical students have recognized and advocated for opportunities to explore various specialties earlier in their medical education. A brief literature review, however, reveals little consensus on the best approach to introduce students to different fields during their preclinical years. We present one of the first reports of a student-led effort to design and implement a preclinical specialty-specific elective. At Mayo Medical School, for two consecutive years the student president of the Pediatric Interest Group has created a peer-designed weeklong group elective ("selective") experience consisting of workshops, faculty and resident panel discussions, and clinical shadowing experiences based on a student needs assessment. Each year, more than 25% of the first- and second-year medical student body participated. The majority of students who completed the selective agreed that this experience heightened their interests and expanded their knowledge about pediatrics. The pediatric group selective has provided students with important resources for their medical education and future careers. Students found the group selective beneficial to their learning experience and recommend continuing to offer it in the future.

  2. Specification for high voltage cable plug and socket connections for medical X-ray equipment

    International Nuclear Information System (INIS)

    1980-01-01

    Under the direction of the Light Engineering Standards Committee, a British Standard Specification has been prepared for three-conductor and four-conductor high-voltage cable plug and socket connections for medical X-ray equipment. The standard deals with the essential dimensions to ensure mechanical interchangeability, the recommended dimensions, the wiring connections to contacts of plug and socket and the marking of contacts of plug and socket. (U.K.)

  3. Empathy in children with autism and conduct disorder: group-specific profiles and developmental aspects.

    Science.gov (United States)

    Schwenck, Christina; Mergenthaler, Julia; Keller, Katharina; Zech, Julie; Salehi, Sarah; Taurines, Regina; Romanos, Marcel; Schecklmann, Martin; Schneider, Wolfgang; Warnke, Andreas; Freitag, Christine M

    2012-06-01

      A deficit in empathy is discussed to underlie difficulties in social interaction of children with autism spectrum disorder (ASD) and conduct disorder (CD). To date, no study has compared children with ASD and different subtypes of CD to describe disorder-specific empathy profiles in clinical samples. Furthermore, little is known about age influences on the development of empathic skills. The aim of the current study was to compare cognitive and emotional empathy in different age groups of children with ASD, CD with elevated or low callous-unemotional-traits (CU+ vs. CU-) and a matched control group (CG).   Fifty-five boys with ASD, 36 boys with CD-CU+, 34 boys with CD-CU- and 67 controls were included. The study implemented three tasks on emotion recognition, perspective taking and emotional affection induced by another person's situation. Multivariate Analysis of variance with the factors group and age (median split) including their interaction term was performed to describe disorder-specific profiles.   Empathy profiles showed differential impairment in children with ASD and CD-CU+. Boys with ASD were impaired in cognitive empathy while participants with CD-CU+ were impaired in emotional empathy. Children with CD-CU- did not differ from the CG. However, boys with CD-CU- were less emotionally reactive in response to film stimuli than children with ASD. Furthermore, we found strong age effects indicating an increase in cognitive and affective empathic skills beyond early infancy in all groups.   In this study, distinct empathic profiles in children with ASD and CD-CU+ were found. Furthermore, the work demonstrates improvement of empathic skills throughout childhood and adolescence, which is comparable for individuals with psychiatric disorders and control children. These results yield implications for further research as well as for therapeutic interventions. © 2011 The Authors. Journal of Child Psychology and Psychiatry © 2011 Association for Child and

  4. Remembering rejection: specificity and linguistic styles of autobiographical memories in borderline personality disorder and depression.

    Science.gov (United States)

    Rosenbach, Charlotte; Renneberg, Babette

    2015-03-01

    High levels of rejection sensitivity are assumed to be the result of early and prolonged experiences of rejection. Aim of this study was to investigate autobiographical memories of rejection in clinical samples high in rejection sensitivity (Borderline Personality Disorder, BPD, and Major Depressive Disorder, MDD) and to identify group differences in the quality of the memories. Memories of rejection were retrieved using an adapted version of the Autobiographical Memory Test (AMT; five positive cue words, five cue words referring to rejection). Specificity of memories and linguistic word usage was analyzed in 30 patients with BPD, 27 patients with MDD and 30 healthy controls. Patients with BPD retrieved less specific memories compared to the healthy control group, whereas patients with MDD did not differ from controls in this regard. The group difference was no longer significant when controlling for rejection sensitivity. Linguistic analysis indicated that compared to both other groups, patients with BPD showed a higher self-focus, used more anger-related words, referred more frequently to social environments, and rated memories of rejection as more relevant for today's life. Clinical symptoms were not assessed in the control group. Moreover, the written form of the AMT might reduce the total number of specific memories. The level of rejection sensitivity influenced the specificity of the retrieved memories. Analysis of linguistic styles revealed specific linguistic patterns in BPD compared to non-clinical as well as depressed participants. Copyright © 2014 Elsevier Ltd. All rights reserved.

  5. Medications Used for Cognitive Enhancement in Patients With Schizophrenia, Bipolar Disorder, Alzheimer's Disease, and Parkinson's Disease.

    Science.gov (United States)

    Hsu, Wen-Yu; Lane, Hsien-Yuan; Lin, Chieh-Hsin

    2018-01-01

    Cognitive impairment, which frequently occurs in patients with schizophrenia, bipolar disorder, Alzheimer's disease, and Parkinson's disease, has a significant impact on the daily lives of both patients and their family. Furthermore, since the medications used for cognitive enhancement have limited efficacy, the issue of cognitive enhancement still remains a clinically unsolved challenge. We reviewed the clinical studies (published between 2007 and 2017) that focused on the efficacy of medications used for enhancing cognition in patients with schizophrenia, bipolar disorder, Alzheimer's disease, and Parkinson's disease. Acetylcholinesterase inhibitors and memantine are the standard treatments for Alzheimer's disease and Parkinson's disease. Some studies have reported selective cognitive improvement in patients with schizophrenia following galantamine treatment. Newer antipsychotics, including paliperidone, lurasidone, aripiprazole, ziprasidone, and BL-1020, have also been reported to exert cognitive benefits in patients with schizophrenia. Dopaminergic medications were found to improve language function in patients with Parkinson's disease. However, no beneficial effects on cognitive function were observed with dopamine agonists in patients with schizophrenia. The efficacies of nicotine and its receptor modulators in cognitive improvement remain controversial, with the majority of studies showing that varenicline significantly improved the cognitive function in schizophrenic patients. Several studies have reported that N -methyl-d-aspartate glutamate receptor (NMDAR) enhancers improved the cognitive function in patients with chronic schizophrenia. NMDAR enhancers might also have cognitive benefits in patients with Alzheimer's disease or Parkinson's disease. Raloxifene, a selective estrogen receptor modulator, has also been demonstrated to have beneficial effects on attention, processing speed, and memory in female patients with schizophrenia. Clinical trials with

  6. Prevalence of specific developmental disorder of scholastic skill in school students in Chandigarh, India

    Directory of Open Access Journals (Sweden)

    Priti Arun

    2013-01-01

    Full Text Available Background & objectives: Several studies have been conducted in India to determine the prevalence of learning disabilities in school children which has been reported to be 3-10 per cent among students population. The present study was conducted to find out prevalence of specific developmental disorder of scholastic skills in students of classes VII to XII and to find out feasibility of screening tool in Chandigarh, India. Methods: A cross-sectional study on school students was carried out in two phases. The students were drawn from classes VII to XII from 10 schools of Chandigarh, India. Details of academic performance of all the students was taken, subjectively from class teachers and objectively from the marks obtained in the last academic session. In phase I, 2402 students were assessed. In phase II, 108 students were randomly selected for evaluation for assessing sensitivity and specificity of screening proforma for teachers. A total of 124 students from phase I and all students in phase II were assessed in detail. Tests of intelligence (Malin′s Intelligence Scale for Indian Children and Standard Progressive Matrices, and NIMHANS Index for specific learning disability (SLD battery were administered. Results: A total of 38 students were found to be having specific developmental disorder of scholastic skills in phase I, that gave a prevalence of 1.58 per cent. Majority had mixed type of errors on SLD battery. There were more boys diagnosed with specific learning disability. Teacher′s screening instrument had high sensitivity (90.385 and specificity (94.68. Interpretation & conclusions: The findings of our study conducted in community, showed that specific learning disability was not identified even till later age. The screening instrument thus could be used by teachers to suspect students with specific learning disability.

  7. Sensitivity and specificity of the amer dizziness diagnostic scale (adds) for patients with vestibular disorders.

    Science.gov (United States)

    Al Saif, Amer; Alsenany, Samira

    2015-01-01

    [Purpose] To investigate the sensitivity and specificity of a newly developed diagnostic tool, the Amer Dizziness Diagnostic Scale (ADDS), to evaluate and differentially diagnose vestibular disorder and to identify the strengths and weaknesses of the scale and its usefulness in clinical practice. [Subjects and Methods] Two hundred subjects of both genders (72 males, 128 females) aged between 18 to 60 (49.5±7.8) who had a history of vertigo and/or dizziness symptoms for this previous two weeks or less were recruited for the study. All subjects were referred by otolaryngologists, neurologists or family physicians in and around Jeddah, Kingdom of Saudi Arabia. On the first clinic visit, all the patients were evaluated once using the ADDS, following which they underwent routine testing of clinical signs and symptoms, audiometry, and a neurological examination, coupled with tests of Vestibulo-Ocular Reflex function, which often serves as the "gold standard" for determining the probability of a vestibular deficit. [Results] The results show that the ADDS strongly correlated with "true-positive" and "true-negative" responses for determining the probability of a vestibular disorder (r =0.95). A stepwise linear regression was conducted and the results indicate that the ADDS was a significant predictor of "true-positive" and "true-negative" responses in vestibular disorders (R(2) =0.90). Approximately 90% of the variability in the vestibular gold standard test was explained by its relationship to the ADDS. Moreover, the ADDS was found to have a sensitivity of 96% and a specificity of 96%. [Conclusion] This study showed that the Amer Dizziness Diagnostic Scale has high sensitivity and specificity and that it can be used as a method of differential diagnosis for patients with vestibular disorders.

  8. Tinnitus in Temporomandibular Joint Disorders: Is it a Specific Somatosensory Tinnitus Subtype?

    Science.gov (United States)

    Algieri, Giuseppe Maria Antonio; Leonardi, Alessandra; Arangio, Paolo; Vellone, Valentino; Paolo, Carlo Di; Cascone, Piero

    2017-04-19

    The most significant otologic symptoms, consisting of ear pain, tinnitus, dizziness, hearing loss and auricolar "fullness", generally arise within the auditory system, often are associated with extra auricolar disorders, particularly disorder of the temporo-mandibular joint. In our study we examined a sample of 200 consecutive patients who had experienced severe disabling symptom. The patiens came to maxillofacial specialist assessment for temporomandibular disorder. Each patient was assessed by a detailed anamnestic and clinical temporomandibular joint examination and they are divided into five main groups according classification criteria established by Wilkes; tinnitus and subjective indicators of pain are evaluated. The results of this study provide a close correlation between the joint pathology and otologic symptoms, particularly regarding tinnitus and balance disorders, and that this relationship is greater the more advanced is the stage of joint pathology. Moreover, this study shows that TMD-related tinnitus principally affects a younger population (average fifth decade of life) and mainly women (more than 2/3 of the cases). Such evidence suggests the existence of a specific tinnitus subtype that may be defined as "TMD-related somatosensory tinnitus".

  9. The specificity of emotional switching in borderline personality disorder in comparison to other clinical groups.

    Science.gov (United States)

    Houben, Marlies; Bohus, Martin; Santangelo, Philip S; Ebner-Priemer, Ulrich; Trull, Timothy J; Kuppens, Peter

    2016-04-01

    In an attempt to better understand the nature of emotion dysregulation in the daily lives of persons with a borderline personality disorder (BPD), Houben et al. (2016) recently identified emotional switching, which refers to the tendency to make large changes between positive and negative emotional states over time, as a possible defining characteristic of the emotion dynamics observed in BPD. The goal of this study was to examine the specificity of these previous findings in 2 samples by comparing BPD patients (N = 43 in sample 1; N = 81 in sample 2) to patients with bulimia nervosa (N = 20), posttraumatic stress disorder (N = 28), or healthy controls (N = 28) in sample 1, and to patients with depressive disorder (N = 50) in sample 2, with respect to measures of emotional switching. Analyses of these 2 experience sampling datasets revealed that contrary to expectations, BPD patients did not differ from the clinical groups regarding their mere tendency to switch between positive and negative emotional states on consecutive moments over time and regarding the magnitude of such changes between positive and negative emotional states over time. However, all clinical groups did differ from healthy controls regarding all switch measures in dataset 1. These results indicate that emotional switching, similar to other more traditional indicators of overall changes in emotional intensity in daily life, might reflect a feature of emotional responding characterizing a range of disorders with mood disturbances. (c) 2016 APA, all rights reserved).

  10. More medical comorbidities in patients with bipolar disorder from the United States than from the Netherlands and Germany

    NARCIS (Netherlands)

    Post, R.M.; Altshuler, L.L.; Leverich, G.S.; Frye, M.A.; Suppes, T.; McElroy, S.L.; Keck, P.E.; Nolen, W.A.; Kupka, R.W.; Grunze, H.; Rowe, M.

    2014-01-01

    Medical comorbidities are common in patients with bipolar (BP) disorder but have not been previously examined for differences between United States and Europe. More than 900 outpatients with BP I and BP II disorder (mean age, 41 years) filled out a questionnaire including the occurrence of 30 listed

  11. More Medical Comorbidities in Patients With Bipolar Disorder From the United States Than From the Netherlands and Germany

    NARCIS (Netherlands)

    Post, Robert M.; Altshuler, Lori L.; Leverich, Gabriele S.; Frye, Mark A.; Suppes, Trish; McElroy, Susan L.; Keck, Paul E.; Nolen, Willem A.; Kupka, Ralph W.; Grunze, Heinz; Rowe, Mike

    Medical comorbidities are common in patients with bipolar (BP) disorder but have not been previously examined for differences between United States and Europe. More than 900 outpatients with BP I and BP II disorder (mean age, 41 years) filled out a questionnaire including the occurrence of 30 listed

  12. Motor Skills of Children Newly Diagnosed with Attention Deficit Hyperactivity Disorder Prior to and Following Treatment with Stimulant Medication

    Science.gov (United States)

    Brossard-Racine, Marie; Shevell, Michael; Snider, Laurie; Belanger, Stacey Ageranioti; Majnemer, Annette

    2012-01-01

    Motor difficulties are common in children with Attention Deficit Hyperactivity Disorder (ADHD). Although preliminary evidence has suggested that methylphenidate can improve the motor skills in children with ADHD and Developmental Coordination Disorder (DCD), the effect of stimulant medication on motor performance in children newly diagnosed with…

  13. Body Dysmorphic Disorder: Gender differences and prevalence in a Pakistani medical student population

    Directory of Open Access Journals (Sweden)

    Vaqar Talha

    2008-04-01

    Full Text Available Abstract Background Body dysmorphic disorder (BDD is a psychiatric disorder characterized by a preoccupation with an imagined or slight defect which causes significant distress or impairment in functioning. Few studies have assessed gender differences in BDD in a non clinical population. Also no study assessed BDD in medical students. This study was designed to determine the point prevalence of BDD in Pakistani medical students and the gender differences in prevalence of BDD, body foci of concern and symptoms of BDD. Methods The medical students enrolled in a medical university in Karachi, Pakistan filled out a self-report questionnaire which assessed clinical features of BDD. BDD was diagnosed according to the DSM-IV criteria. Results Out of the 156 students, 57.1% were female. A total of 78.8% of the students reported dissatisfaction with some aspect of their appearance and 5.8% met the DSM-IV criteria for BDD. The male to female ratio for BDD was 1.7. Regarding gender differences in body foci of concern, the top three reported foci of concern in male students were head hair (34.3%, being fat (32.8%, skin (14.9% and nose(14.9%, whereas in females they were being fat (40.4%, skin (24.7% and teeth (18%. Females were significantly more concerned about being fat (p = 0.005. Male students were significantly more concerned about being thin (p = 0.01 and about head hair (p = 0.012. Conclusion BDD is fairly common in our medical student population, with a higher prevalence in males. Important gender differences in BDD symptomatology and reported body foci of concern were identified which reflected the influence of media on body image perception. The impact of cultural factors on the prevalence as well as gender differences in BDD symptomatology was also established.

  14. Memory deficit in patients with schizophrenia and posttraumatic stress disorder: relational vs item-specific memory

    Directory of Open Access Journals (Sweden)

    Jung W

    2016-05-01

    Full Text Available Wookyoung Jung,1 Seung-Hwan Lee1,2 1Clinical Emotions and Cognition Research Laboratory, Department of Psychiatry, Inje University, Ilsan-Paik Hospital, 2Department of Psychiatry, Inje University, Ilsan-Paik Hospital, Goyang, Korea Abstract: It has been well established that patients with schizophrenia have impairments in cognitive functioning and also that patients who experienced traumatic events suffer from cognitive deficits. Of the cognitive deficits revealed in schizophrenia or posttraumatic stress disorder (PTSD patients, the current article provides a brief review of deficit in episodic memory, which is highly predictive of patients’ quality of life and global functioning. In particular, we have focused on studies that compared relational and item-specific memory performance in schizophrenia and PTSD, because measures of relational and item-specific memory are considered the most promising constructs for immediate tangible development of clinical trial paradigm. The behavioral findings of schizophrenia are based on the tasks developed by the Cognitive Neuroscience Treatment Research to Improve Cognition in Schizophrenia (CNTRICS initiative and the Cognitive Neuroscience Test Reliability and Clinical Applications for Schizophrenia (CNTRACS Consortium. The findings we reviewed consistently showed that schizophrenia and PTSD are closely associated with more severe impairments in relational memory compared to item-specific memory. Candidate brain regions involved in relational memory impairment in schizophrenia and PTSD are also discussed. Keywords: schizophrenia, posttraumatic stress disorder, episodic memory deficit, relational memory, item-specific memory, prefrontal cortex, hippocampus

  15. The pathophysiology, medical management and dental implications of adult attention-deficit/hyperactivity disorder.

    Science.gov (United States)

    Friedlander, Arthur H; Yagiela, John A; Mahler, Michael E; Rubin, Robert

    2007-04-01

    Few published reports in the dental literature have focused on adult attention-deficit/hyperactivity disorder (ADHD) and its dental implications. The authors conducted a MEDLINE search for the period 2000 through 2005 using the terms "adult" and "attention-deficit" to define ADHD's pathology, medical treatment and dental implications. ADHD is a developmental condition that affects slightly more than 4 percent of the adult U.S. population. Its symptoms include inattention, hyperactivity and impulsivity that can cause personal, social, occupational and leisure-time dysfunction. Medications used to treat the disorder include stimulants, selective noradrenergic uptake inhibitors and tricyclic antidepressants. The oral health of people with ADHD may be compromised by inattention and impulsivity that impair home care regimens and can lead to cigarette addiction, which may cause oral cancer and damage the periodontium, and excessive ingestion of caffeinated sugar-laden soft drinks that promote dental caries. To safely care for this patient population, dentists must be familiar with the stimulant and nonstimulant medications used to treat adult ADHD, because these drugs can cause adverse orofacial and systemic reactions and interact adversely with dental therapeutic agents.

  16. Disease-specific hashtags and the creation of Twitter medical communities in hematology and oncology.

    Science.gov (United States)

    Pemmaraju, Naveen; Thompson, Michael A; Qazilbash, Muzaffar

    2017-10-01

    Twitter is being increasingly used for information gathering and dissemination of ideas in both medical practice and scientific research. A major limitation to its use has been the surplus of available information and difficulty in categorizing that information into topics of individual interest. However, a Twitter feature known as the hashtag (#), which denotes a specific category or topic, helps in streamlining this wealth of information. The creation and adoption of disease-specific hashtags by healthcare stakeholders has led to a greater uniformity of medical discussions that can be retrieved and referenced at later time-points. As new disease-specific hashtags are created for hematologic and oncologic diseases, more users can connect across the world, even for the rarest of cancer subtypes. A major challenge for this emerging application will be the development of specific and easily identifiable hashtags over time to add more clarity, while still trying to grow Twitter users and expand its reach. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Phase synchronization of oxygenation waves in the frontal areas of children with attention-deficit hyperactivity disorder detected by optical diffusion spectroscopy correlates with medication

    Science.gov (United States)

    Wigal, Sharon B.; Polzonetti, Chiara M.; Stehli, Annamarie; Gratton, Enrico

    2012-12-01

    The beneficial effects of pharmacotherapy on children with attention-deficit hyperactivity disorder (ADHD) are well documented. We use near-infrared spectroscopy (NIRS) methodology to determine reorganization of brain neurovascular properties following the medication treatment. Twenty-six children with ADHD (ages six through 12) participated in a modified laboratory school protocol to monitor treatment response with lisdexamfetamine dimesylate (LDX; Vyvanse, Shire US Inc.). All children refrained from taking medication for at least two weeks (washout period). To detect neurovascular reorganization, we measured changes in synchronization of oxy (HbO2) and deoxy (HHb) hemoglobin waves between the two frontal lobes. Participants without medication displayed average baseline HbO2 phase difference at about -7-deg. and HHb differences at about 240-deg.. This phase synchronization index changed after pharmacological intervention. Medication induced an average phase changes of HbO2 after first medication to 280-deg. and after medication optimization to 242-deg.. Instead first medication changed of the average HHb phase difference at 186-deg. and then after medication optimization to 120-deg. In agreement with findings of White et al., and Varela et al., we associated the phase synchronization differences of brain hemodynamics in children with ADHD with lobe specific hemodynamic reorganization of HbO2- and HHB oscillations following medication status.

  18. Psychiatric disorders, psychotropic medication use and falls among women: an observational study.

    Science.gov (United States)

    Williams, Lana J; Pasco, Julie A; Stuart, Amanda L; Jacka, Felice N; Brennan, Sharon L; Dobbins, Amelia G; Honkanen, Risto; Koivumaa-Honkanen, Heli; Rauma, Päivi H; Berk, Michael

    2015-04-08

    Psychotropic agents known to cause sedation are associated with an increased risk of falls, but the role of psychiatric illness as an independent risk factor for falls is not clear. Thus, this study aimed to investigate the association between psychiatric disorders, psychotropic medication use and falls risk. This study examined data collected from 1062 women aged 20-93 yr (median 50 yr) participating in the Geelong Osteoporosis Study, a large, ongoing, population-based study. Depressive and anxiety disorders for the preceding 12-month period were ascertained by clinical interview. Current medication use and falls history were self-reported. Participants were classified as fallers if they had fallen to the ground at least twice during the same 12-month period. Anthropometry, demographic, medical and lifestyle factors were determined. Logistic regression was used to test the associations, after adjusting for potential confounders. Fifty-six women (5.3%) were classified as fallers. Those meeting criteria for depression within the past 12 months had a 2.4-fold increased odds of falling (unadjusted OR = 2.4, 95% CI 1.2-4.5). Adjustment for age and mobility strengthened the relationship (adjusted OR = 2.7, 95% CI 1.4-5.2) between depression and falling, with results remaining unchanged following further adjustment for psychotropic medication use (adjusted OR = 2.7, 95% CI 1.3-5.6). In contrast, past (prior to 12-month) depression were not associated with falls. No association was observed between anxiety and falls risk. Falling was associated with psychotropic medication use (unadjusted OR = 2.8, 95% CI 1.5-5.2), as well as antidepressant (unadjusted OR = 2.4, 95% CI 1.2-4.8) and benzodiazepine use (unadjusted OR = 3.4, 95% CI 1.6-7.3); associations remained unchanged following adjustment for potential confounders. The likelihood of falls was increased among those with depression within the past 12 months, independent of psychotropic medication

  19. Attention Deficit Hyperactivity Disorder Medication Use Among Teens and Young Adults.

    Science.gov (United States)

    Johansen, Michael E; Matic, Kathleen; McAlearney, Ann Scheck

    2015-08-01

    The purpose of this study was to determine rates of stimulant/atomoxetine use among teens (aged 12-17 years) and young adults (aged 18-23 years) and to investigate associations in medication use before and after the transition from teen to young adult. Repeated cross-sectional analyses using the nationally representative Medical Expenditure Panel Survey. The sample included all teens and young adults between 2003 and 2012. Within this group, a staggered sample of individuals between 2006 and 2012 born during a 5-year range was used to minimize false positive findings due to temporal trends. The primary outcome was attention deficit hyperactivity disorder (ADHD) medication use (two or more prescriptions and ≥60 tablets). A multivariable logistic regression was utilized to determine associations between ADHD medication use and race/ethnicity and other sociodemographic factors. A total of 62,699 individuals were included between 2003 and 2012. Rates of ADHD medication use increased for both teens (4.2%-6.0%) and young adults (1.2%-2.6%) between 2003-2004 and 2011-2012. In adjusted analysis, blacks, Hispanics, and Asians had lower rates of use compared with whites. The decrease in use among young adults was more pronounced among blacks compared with whites. A usual source of care and health insurance were less common among young adults, and both were associated with ADHD medication use. Although there has been an increase in the use of ADHD medications in both teens and young adults, we found a drop-off in levels of ADHD treatment among young adults when compared with teens. A portion of this decrease appears to be related to race/ethnicity, usual source of care, and health insurance status. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  20. Assessing the specificity of posttraumatic stress disorder's dysphoric items within the dysphoria model.

    Science.gov (United States)

    Armour, Cherie; Shevlin, Mark

    2013-10-01

    The factor structure of posttraumatic stress disorder (PTSD) currently used by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), has received limited support. A four-factor dysphoria model is widely supported. However, the dysphoria factor of this model has been hailed as a nonspecific factor of PTSD. The present study investigated the specificity of the dysphoria factor within the dysphoria model by conducting a confirmatory factor analysis while statistically controlling for the variance attributable to depression. The sample consisted of 429 individuals who met the diagnostic criteria for PTSD in the National Comorbidity Survey. The results concluded that there was no significant attenuation in any of the PTSD items. This finding is pertinent given several proposals for the removal of dysphoric items from the diagnostic criteria set of PTSD in the upcoming DSM-5.

  1. Children and adolescents with gender identity disorder referred to a pediatric medical center.

    Science.gov (United States)

    Spack, Norman P; Edwards-Leeper, Laura; Feldman, Henry A; Leibowitz, Scott; Mandel, Francie; Diamond, David A; Vance, Stanley R

    2012-03-01

    To describe the patients with gender identity disorder referred to a pediatric medical center. We identify changes in patients after creation of the multidisciplinary Gender Management Service by expanding the Disorders of Sex Development clinic to include transgender patients. Data gathered on 97 consecutive patients gender behaviors, provided letters from current mental health professional, and parental support. Main descriptive measures included gender, age, Tanner stage, history of gender identity development, and psychiatric comorbidity. Genotypic male:female ratio was 43:54 (0.8:1); there was a slight preponderance of female patients but not significant from 1:1. Age of presentation was 14.8 ± 3.4 years (mean ± SD) without sex difference (P = .11). Tanner stage at presentation was 4.1 ± 1.4 for genotypic female patients and 3.6 ± 1.5 for genotypic male patients (P = .02). Age at start of medical treatment was 15.6 ± 2.8 years. Forty-three patients (44.3%) presented with significant psychiatric history, including 20 reporting self-mutilation (20.6%) and suicide attempts (9.3%). After establishment of a multidisciplinary gender clinic, the gender identity disorder population increased fourfold. Complex clinical presentations required additional mental health support as the patient population grew. Mean age and Tanner Stage were too advanced for pubertal suppressive therapy to be an affordable option for most patients. Two-thirds of patients were started on cross-sex hormone therapy. Greater awareness of the benefit of early medical intervention is needed. Psychological and physical effects of pubertal suppression and/or cross-sex hormones in our patients require further investigation.

  2. Procedural learning in Parkinson's disease, specific language impairment, dyslexia, schizophrenia, developmental coordination disorder, and autism spectrum disorders: A second-order meta-analysis.

    Science.gov (United States)

    Clark, Gillian M; Lum, Jarrad A G

    2017-10-01

    The serial reaction time task (SRTT) has been used to study procedural learning in clinical populations. In this report, second-order meta-analysis was used to investigate whether disorder type moderates performance on the SRTT. Using this approach to quantitatively summarise past research, it was tested whether autism spectrum disorder, developmental coordination disorder, dyslexia, Parkinson's disease, schizophrenia, and specific language impairment differentially affect procedural learning on the SRTT. The main analysis revealed disorder type moderated SRTT performance (p=0.010). This report demonstrates comparable levels of procedural learning impairment in developmental coordination disorder, dyslexia, Parkinson's disease, schizophrenia, and specific language impairment. However, in autism, procedural learning is spared. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Medical Geography and Topography Works: the first environmental studies in a specific city

    Directory of Open Access Journals (Sweden)

    Angela Lúcia de Araújo Ferreira

    2012-02-01

    Full Text Available The natural environment and the geographical circumstances set the basis for the development of an hygiene-oriented thinking and led physicians to investigate and diagnose the regional and urban space between the eighteenth and twentieth centuries. These ideas were systematically compiled in works known as Medical Geography and Topography Works which, when known throughout the world, ended up becoming precise descriptions of the cities' territory, providing a spatial account of diseases and identifying their nature, evolution and treatment. Besides recovering the origin of these treaties and stressing their importance as amongst the first "geographical" investigations of urban space, this work aims to include Brazil, and specifically the city of Natal (in northeast Brazil within the context of these analyses, with special emphasis on the work entitled Topography of Natal and its Medical Geography authored by doctor Januário Cicco in 1920.

  4. Relationship of clinical course of illness variables to medical comorbidities in 900 adult outpatients with bipolar disorder'

    NARCIS (Netherlands)

    Post, Robert M.; Altshuler, Lori; Leverich, Gabriele S.; Frye, Mark A.; Suppes, Trish; McElroy, Susan L.; Keck, Paul E.; Nolen, Willem A.; Kupka, Ralph W.; Grunze, Heinz; Rowe, Mike

    2015-01-01

    BACKGROUND: Medical illnesses are highly comorbid with bipolar disorder, but their relationship to illness characteristics has not been previously delineated. METHODS: The incidence of 34 medical conditions and 6 poor prognosis factors (PPFs) was derived from answers to a questionnaire in over 900

  5. Relationship of clinical course of illness variables to medical comorbidities in 900 adult outpatients with bipolar disorder'

    NARCIS (Netherlands)

    Post, R.M.; Altshuler, L.; Leverich, G.S.; Frye, M.A.; Suppes, T.; McElroy, S.L.; Keck, P.E.; Nolen, W.A.; Kupka, R.W.; Grunze, H.; Rowe, M.

    2015-01-01

    Background Medical illnesses are highly comorbid with bipolar disorder, but their relationship to illness characteristics has not been previously delineated. Methods The incidence of 34 medical conditions and 6 poor prognosis factors (PPFs) was derived from answers to a questionnaire in over 900

  6. Specific Aspects of Forecasting and Perception of the Norm by Juniour Schoolchildren with Developmental Disorders

    Directory of Open Access Journals (Sweden)

    Anna I. Akhmetzyanova

    2017-09-01

    Full Text Available Introduction: juniour schoolchildren with special needs should take into account the existing system of norms and rules in the school space. They should understand both their own inner world and that of surrounding people, but in conditions of deficiency dysontogenesis, the inability to forecast the outcome of any situation and the use of irrational behavioural strategies reduce the opportunities for successful social adaptation. The purpose of this study is to identify the specifics of forecasting and understanding normative situations by juniour schoolchildren with musculoskeletal system disorder, as well as with vision, hearing and speech impairment. Materials and Methods: to study the forecasting specifics of juniour schoolchildren, we used the guessing game methodology by L. I. Peresleni. We studied the specific character of normative behaviour using a set of methodologies: Perception of the normative situation by A. K. Pashchenko, Anticipation of the outcome with violation of the norm by V. P. Ulyanova, and Identification of the cultural congruity of juniour schoolchildren by L. F. Bayanova. Results: the study made it possible to identify the forecasting characteristics of juniour schoolchildren with normative development and with vision, hearing, speech impairments and musculoskeletal disorder. Students with developmental disabilities experienced forecasting difficulties, associated with decreasing sustainability of voluntary attention and its distribution in the course of the activity. The perception of norms by schoolchildren with developmental disorders often depended on random, brightly coloured emotional events or objects. The norms were differentiated more successfully in a situation of communication, than in educational activity. Discussion and Conclusions: the obtained data are consistent with the results of the studies by national and foreign scientists, who note that children with health limitations lack understanding of the

  7. Social, psychological and psychosomatic disorders in the people with combat stress in their medical histories

    Directory of Open Access Journals (Sweden)

    L. V. Gracheva

    2013-01-01

    Full Text Available The authors examined three groups of patients – military men (40 men in each group with combat stress of different intensity in their medical histories (two main groups and a  control group – without combat stress. The results showed that the military men with a high level combat stress in the past (more than 5 years ago more frequently demonstrated socialmental disadaptation against the background of subclinical chronic posttraumatic stress disorder (PTSD. The conclusion is that this group of people requires dynamic followup and adequate medicopsychological aid.

  8. Creating Patient-Specific Neural Cells for the In Vitro Study of Brain Disorders

    Directory of Open Access Journals (Sweden)

    Kristen J. Brennand

    2015-12-01

    Full Text Available As a group, we met to discuss the current challenges for creating meaningful patient-specific in vitro models to study brain disorders. Although the convergence of findings between laboratories and patient cohorts provided us confidence and optimism that hiPSC-based platforms will inform future drug discovery efforts, a number of critical technical challenges remain. This opinion piece outlines our collective views on the current state of hiPSC-based disease modeling and discusses what we see to be the critical objectives that must be addressed collectively as a field.

  9. Impact of Attention-Deficit Hyperactivity Disorder on School Performance: What are the Effects of Medication?

    Science.gov (United States)

    Baweja, Raman; Mattison, Richard E; Waxmonsky, James G

    2015-12-01

    Attention-deficit hyperactivity disorder (ADHD) affects an estimated 5-7 % of schoolchildren worldwide. School functioning and academic achievement are frequently impaired by ADHD and represent one of the main reasons children start ADHD medication. Multiple potential causal pathways exist between ADHD and impaired school performance. In this review, we decompose school performance into three components and assess the impact of ADHD and its treatments on academic performance (assessed by grade point average [GPA], time on-task, percentage of work completed as well as percent completed correctly), academic skills (as measured by achievement tests and cognitive measures), and academic enablers (such as study skills, motivation, engagement, classroom behavior and interpersonal skills). Most studies examined only the short-term effects of medication on school performance. In these, ADHD medications have been observed to improve some aspects of school performance, with the largest impact on measures of academic performance such as seatwork productivity and on-task performance. In a subset of children, these benefits may translate into detectable improvements in GPA and achievement testing. However, limited data exists to support whether these changes are sustained over years. Optimizing medication effects requires periodic reassessment of school performance, necessitating a collaborative effort involving patients, parents, school staff and prescribers. Even with systematic reassessment, behavioral-based treatments and additional school-based services may be needed to maximize academic performance for the many youth with ADHD and prominent impairments in school performance.

  10. Parental perceptions and satisfaction with stimulant medication for attention-deficit hyperactivity disorder.

    Science.gov (United States)

    Dosreis, Susan; Zito, Julie Magno; Safer, Daniel J; Soeken, Karen L; Mitchell, John W; Ellwood, Leslie C

    2003-06-01

    Few reports have documented parental perceptions of stimulants for attention-deficit hyperactivity disorder (ADHD), despite the recent increased use of stimulants among youths. Of 302 parents recruited from six pediatric primary care clinics, 84% completed a survey of their knowledge, attitudes, and satisfaction with the medication their child was taking for ADHD. Two thirds of the parents believed that sugar and diet affect hyperactivity. Although few parents believed that stimulants could lead to drug abuse, 55% initially were hesitant to use medication on the basis of information in the lay press, and 38% believed that too many children receive medication for ADHD. Parents were more satisfied with the behavioral and academic improvement relative to improvement in their child's self-esteem. Attitudes were positively correlated with satisfaction and were more positive among white than nonwhite parents. The findings highlight parental misconceptions and reservations about ADHD medication treatment that require clarification as to whether race/ethnicity, income, and social status influence their views and use of treatments.

  11. Reduced specificity of autobiographical memories in young people with tic disorders.

    Science.gov (United States)

    Pile, Victoria; Robinson, Sally; Roberts, Elystan; Topor, Marta; Hedderly, Tammy; Lau, Jennifer Y F

    2018-05-01

    Depression is common in Tourette syndrome and Chronic Tic Disorders (TS/CTD) and contributes to significant impairment. The specificity of autobiographical memories is implicated in an individual's sense of self and their daily functioning but also in the onset and development of depression in the general population. Here, we examined whether memory specificity is reduced in young people with TS/CTD, relative to control participants, and whether memory specificity is associated with depression. Thirty young people with TS/CTD (14 females; age: x̅ = 11.31; SD = 1.66; 87% White British) and twenty-six (12 females; age: x̅ = 11.23; SD = 2.43; 77% White British) control participants completed the study. Participants completed the Autobiographical Memory Task, which asks participants to respond with a specific memory to cue words, and a questionnaire measure of depressive symptoms. There was no significant difference between the two groups in terms of age, gender, ethnicity, IQ and depressive symptomatology. Young people with TS/CTD had less specific autobiographical memories than their peers (p < 0.001, r = 0.49). Across both groups, increased memory specificity for positive cue words was associated with reduced depressive symptomatology (p < 0.001, R 2  = 0.51). Our findings indicate that autobiographical memory in young people with TS is characterised by a lack of specificity and, as with neurotypical peers, reduced memory specificity for positive words is associated with depressive symptoms. Autobiographical memory specificity could be an important factor in understanding mood symptoms that characterise young people with TS/CTD and may be an important cognitive target to reduce the development of depression in young people with TS/CTD. Copyright © 2018 Elsevier Inc. All rights reserved.

  12. GenderMedDB: an interactive database of sex and gender-specific medical literature.

    Science.gov (United States)

    Oertelt-Prigione, Sabine; Gohlke, Björn-Oliver; Dunkel, Mathias; Preissner, Robert; Regitz-Zagrosek, Vera

    2014-01-01

    Searches for sex and gender-specific publications are complicated by the absence of a specific algorithm within search engines and by the lack of adequate archives to collect the retrieved results. We previously addressed this issue by initiating the first systematic archive of medical literature containing sex and/or gender-specific analyses. This initial collection has now been greatly enlarged and re-organized as a free user-friendly database with multiple functions: GenderMedDB (http://gendermeddb.charite.de). GenderMedDB retrieves the included publications from the PubMed database. Manuscripts containing sex and/or gender-specific analysis are continuously screened and the relevant findings organized systematically into disciplines and diseases. Publications are furthermore classified by research type, subject and participant numbers. More than 11,000 abstracts are currently included in the database, after screening more than 40,000 publications. The main functions of the database include searches by publication data or content analysis based on pre-defined classifications. In addition, registrants are enabled to upload relevant publications, access descriptive publication statistics and interact in an open user forum. Overall, GenderMedDB offers the advantages of a discipline-specific search engine as well as the functions of a participative tool for the gender medicine community.

  13. Diagnostic specificity of poor premorbid adjustment: comparison of schizophrenia, schizoaffective disorder, and mood disorder with psychotic features.

    Science.gov (United States)

    Tarbox, Sarah I; Brown, Leslie H; Haas, Gretchen L

    2012-10-01

    Individuals with schizophrenia have significant deficits in premorbid social and academic adjustment compared to individuals with non-psychotic diagnoses. However, it is unclear how severity and developmental trajectory of premorbid maladjustment compare across psychotic disorders. This study examined the association between premorbid functioning (in childhood, early adolescence, and late adolescence) and psychotic disorder diagnosis in a first-episode sample of 105 individuals: schizophrenia (n=68), schizoaffective disorder (n=22), and mood disorder with psychotic features (n=15). Social and academic maladjustment was assessed using the Cannon-Spoor Premorbid Adjustment Scale. Worse social functioning in late adolescence was associated with higher odds of schizophrenia compared to odds of either schizoaffective disorder or mood disorder with psychotic features, independently of child and early adolescent maladjustment. Greater social dysfunction in childhood was associated with higher odds of schizoaffective disorder compared to odds of schizophrenia. Premorbid decline in academic adjustment was observed for all groups, but did not predict diagnosis at any stage of development. Results suggest that social functioning is disrupted in the premorbid phase of both schizophrenia and schizoaffective disorder, but remains fairly stable in mood disorders with psychotic features. Disparities in the onset and time course of social dysfunction suggest important developmental differences between schizophrenia and schizoaffective disorder. Copyright © 2012 Elsevier B.V. All rights reserved.

  14. Emotional and Meta-Emotional Intelligence as Predictors of Adjustment Problems in Students with Specific Learning Disorders

    Science.gov (United States)

    D'Amico, Antonella; Guastaferro, Teresa

    2017-01-01

    The purpose of this study was to analyse adjustment problems in a group of adolescents with a Specific Learning Disorder (SLD), examining to what extent they depend on the severity level of the learning disorder and/or on the individual's level of emotional intelligence. Adjustment problems,, perceived severity levels of SLD, and emotional and…

  15. A screening on Specific Learning Disorders in an Italian speaking high genetic homogeneity area.

    Science.gov (United States)

    Cappa, Claudia; Giulivi, Sara; Schilirò, Antonino; Bastiani, Luca; Muzio, Carlo; Meloni, Fabrizio

    2015-01-01

    The aim of the present research is to investigate the prevalence of Specific Learning Disorders (SLD) in Ogliastra, an area of the island of Sardinia, Italy. Having experienced centuries of isolation, Ogliastra has become a high genetic homogeneity area, and is considered particularly interesting for studies on different kinds of pathologies. Here we are going to describe the results of a screening carried out throughout 2 consecutive years in 49 second grade classes (24 considered in the first year and 25 in the second year of the study) of the Ogliastra region. A total of 610 pupils (average age 7.54 years; 293 female, 317 male) corresponding to 68.69% of all pupils who were attending second grade in the area, took part in the study. The tool used for the screening was "RSR-DSA. Questionnaire for the detection of learning difficulties and disorders", which allowed the identification of 83 subjects at risk (13.61% of the whole sample involved in the study). These subjects took part in an enhancement training program of about 6 months. After the program, pupils underwent assessment for reading, writing and calculation abilities, as well as cognitive assessment. According to the results of the assessment, the prevalence of SLDs is 6.06%. For what concerns dyslexia, 4.75% of the total sample manifested this disorder either in isolation or in comorbidity with other disorders. According to the first national epidemiological investigation carried out in Italy, the prevalence of dyslexia is 3.1-3.2%, which is lower than the prevalence obtained in the present study. Given the genetic basis of SLDs, this result, together with the presence of several cases of SLD in isolation (17.14%) and with a 3:1 ratio of males to females diagnosed with a SLD, was to be expected in a sample coming from a high genetic homogeneity area. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Cognitive-behavioral therapy induces sensorimotor and specific electrocortical changes in chronic tic and Tourette's disorder.

    Science.gov (United States)

    Morand-Beaulieu, Simon; O'Connor, Kieron P; Sauvé, Geneviève; Blanchet, Pierre J; Lavoie, Marc E

    2015-12-01

    Tic disorders, such as the Gilles de la Tourette syndrome and persistent tic disorder, are neurodevelopmental movement disorders involving impaired motor control. Hence, patients show repetitive unwanted muscular contractions in one or more parts of the body. A cognitive-behavioral therapy, with a particular emphasis on the psychophysiology of tic expression and sensorimotor activation, can reduce the frequency and intensity of tics. However, its impact on motor activation and inhibition is not fully understood. To study the effects of a cognitive-behavioral therapy on electrocortical activation, we recorded the event-related potentials (ERP) and lateralized readiness potentials (LRP), before and after treatment, of 20 patients with tic disorders and 20 healthy control participants (matched on age, sex and intelligence), during a stimulus-response compatibility inhibition task. The cognitive-behavioral therapy included informational, awareness training, relaxation, muscle discrimination, cognitive restructuration and relapse prevention strategies. Our results revealed that prior to treatment; tic patients had delayed stimulus-locked LRP onset latency, larger response-locked LRP peak amplitude, and a frontal overactivation during stimulus inhibition processing. Both stimulus-locked LRP onset latency and response-locked LRP peak amplitude normalized after the cognitive behavioral therapy completion. However, the frontal overactivation related to inhibition remained unchanged following therapy. Our results showed that P300 and reaction times are sensitive to stimulus-response compatibility, but are not related to tic symptoms. Secondly, overactivity of the frontal LPC and impulsivity in TD patients were not affected by treatment. Finally, CBT had normalizing effects on the activation of the pre-motor and motor cortex in TD patients. These results imply specific modifications of motor processes following therapy, while inhibition processes remained unchanged. Given

  17. Specificity of the tomography implementation in electric arc domain - Validity in medical imaging

    International Nuclear Information System (INIS)

    Benech, Julie

    2008-01-01

    The aim of these works was to implement a new experimental method to characterize 3D thermal plasmas by emission spectroscopy. The method used is based on tomographic technique which is widely used in medical imaging nowadays. However, tomography that we have developed and applied to electric arc is specific as the number of accessible projections angles is strongly limited: 4 projections our case against basically 64 in medical imaging. The particularity of our experimental tomographic system is that measurements are resolved both spectrally and spatially. The spectral resolution is necessary to determine the temperature values from method based on atomic line intensity. The spatial resolution is needed to simultaneously acquire the whole width of the plasma and so to reconstruct a whole cross-section in only one acquisition. One of the principal objective was to realize the experimental system of four-view tomography for thermal plasmas. Thanks to this device, we showed that the characterization of non-axisymmetric plasma is possible and that it enables to reconstruct 3D temperature maps. Finally, our tomographic method is applied with medical imaging data acquired in SPECT (Single Photon Emission Computed Tomography). These tests allowed validating the use of our tomographic reconstruction technique in SPECT, particularly the used iterative algebraic algorithm and the limited-view configuration. (author) [fr

  18. PubMed search strategies for the identification of etiologic associations between hypothalamic-pituitary disorders and other medical conditions.

    Science.gov (United States)

    Guaraldi, Federica; Grottoli, Silvia; Arvat, Emanuela; Mattioli, Stefano; Ghigo, Ezio; Gori, Davide

    2013-12-01

    Biomedical literature has enormously grown in the last decades and become broadly available through online databases. Ad-hoc search methods, created on the basis of research field and goals, are required to enhance the quality of searching. Aim of this study was to formulate efficient, evidence-based PubMed search strategies to retrieve articles assessing etiologic associations between a condition of interest and hypothalamic-pituitary disorders (HPD). Based on expert knowledge, 17 MeSH (Medical Subjects Headings) and 79 free terms related to HPD were identified to search PubMed. Using random samples of abstracts retrieved by each term, we estimated the proportion of articles containing pertinent information and formulated two strings (one more specific, one more sensitive) for the detection of articles focusing on the etiology of HPD, that were then applied to retrieve articles identifying possible etiologic associations between HPD and three diseases (malaria, LHON and celiac disease) considered not associated to HPD, and define the number of abstracts needed to read (NNR) to find one potentially pertinent article. We propose two strings: one sensitive string derived from the combination of articles providing the largest literature coverage in the field and one specific including combined terms retrieving ≥40% of potentially pertinent articles. NNR were 2.1 and 1.6 for malaria, 3.36 and 2.29 for celiac disease, 2.8 and 2.2 for LHON, respectively. For the first time, two reliable, readily applicable strings are proposed for the retrieval of medical literature assessing putative etiologic associations between HPD and other medical conditions of interest.

  19. Do symptom-specific stages of change predict eating disorder treatment outcome?

    Science.gov (United States)

    Ackard, Diann M; Cronemeyer, Catherine L; Richter, Sara; Egan, Amber

    2015-03-01

    Interview methods to assess stages of change (SOC) in eating disorders (ED) indicate that SOC are positively correlated with symptom improvement over time. However, interviews require significant time and staff training and global measures of SOC do not capture varying levels of motivation across ED symptoms. This study used a self-report, ED symptom-specific SOC measure to determine prevalence of stages across symptoms and identify if SOC predict treatment outcome. Participants [N = 182; age 13-58 years; 92% Caucasian; 96% female; average BMI 21.7 (SD = 5.9); 50% ED not otherwise specified (EDNOS), 30.8% bulimia nervosa (BN), 19.2% anorexia nervosa (AN)] seeking ED treatment at a diverse-milieu multi-disciplinary facility in the United States completed stages of change, behavioral (ED symptom use and frequency) and psychological (ED concerns, anxiety, depression) measures at intake assessment and at 3, 6 and 12 months thereafter. Descriptive summaries were generated using ANOVA or Kruskal-Wallis (continuous) and χ (2) (categorical) tests. Repeated measures linear regression models with autoregressive correlation structure predicted treatment outcome. At intake assessment, 53.3% of AN, 34.0% of BN and 18.1% of EDNOS patients were in Preparation/Action. Readiness to change specific symptoms was highest for binge-eating (57.8%) and vomiting (56.5%). Frequency of fasting and restricting behaviors, and scores on all eating disorder and psychological measures improved over time regardless of SOC at intake assessment. Symptom-specific SOC did not predict reductions in ED symptom frequency. Overall SOC predicted neither improvement in Eating Disorder Examination Questionnaire (EDE-Q) scores nor reduction in depression or trait anxiety; however, higher overall SOC predicted lower state anxiety across follow-up. Readiness to change ED behaviors varies considerably. Most patients reduced eating disorder behaviors and increased psychological functioning regardless of stages

  20. Symptom-specific self-referential cognitive processes in bipolar disorder: a longitudinal analysis.

    Science.gov (United States)

    Pavlickova, H; Varese, F; Turnbull, O; Scott, J; Morriss, R; Kinderman, P; Paykel, E; Bentall, R P

    2013-09-01

    Although depression and mania are often assumed to be polar opposites, studies have shown that, in patients with bipolar disorder, they are weakly positively correlated and vary somewhat independently over time. Thus, when investigating relationships between specific psychological processes and specific symptoms (mania and depression), co-morbidity between the symptoms and changes over time must be taken into account. Method A total of 253 bipolar disorder patients were assessed every 24 weeks for 18 months using the Hamilton Rating Scale for Depression (HAMD), the Bech-Rafaelsen Mania Assessment Scale (MAS), the Rosenberg Self-Esteem Questionnaire (RSEQ), the Dysfunctional Attitudes Scale (DAS), the Internal, Personal and Situational Attributions Questionnaire (IPSAQ) and the Personal Qualities Questionnaire (PQQ). We calculated multilevel models using the xtreg module of Stata 9.1, with psychological and clinical measures nested within each participant. Mania and depression were weakly, yet significantly, associated; each was related to distinct psychological processes. Cross-sectionally, self-esteem showed the most robust associations with depression and mania: depression was associated with low positive and high negative self-esteem, and mania with high positive self-esteem. Depression was significantly associated with most of the other self-referential measures, whereas mania was weakly associated only with the externalizing bias of the IPSAQ and the achievement scale of the DAS. Prospectively, low self-esteem predicted future depression. The associations between different self-referential thinking processes and different phases of bipolar disorder, and the presence of the negative self-concept in both depression and mania, have implications for therapeutic management, and also for future directions of research.

  1. Grey Matter Abnormalities in Social Anxiety Disorder: Primary, Replication, and Specificity Studies

    Science.gov (United States)

    Talati, Ardesheer; Pantazatos, Spiro P.; Schneier, Franklin R.; Weissman, Myrna M; Hirsch, Joy

    2012-01-01

    Background Despite increasing evidence that neuroanatomical abnormalities underlie pathological anxiety, social anxiety disorder (SAD), although among the most common of anxiety disorders, has received little attention. Using Magnetic Resonance Imaging, we (1) examined grey matter (GM) differences between generalized SAD and healthy control groups; (2) retested the findings in an independent clinical sample; and (3) tested for specificity by contrasting the SAD group to a separate group of panic disorder (PD) subjects. Methods The primary SAD group (N=16) was required to meet DSM-IV criteria for SAD, with onset by age 30; controls (N=20) had no lifetime history of anxiety. The replication sample included 17 generalized SAD and 17 control subjects. The PD comparison group (N=16) was required to have no lifetime SAD. Images were acquired on a 1.5Tesla GE Signa MRI scanner using a 3D T1-weighted spoiled gradient recalled pulse sequence. Morphological differences were determined using voxel based morphometry, in SPM8. Results After adjusting for age, gender, and total intracranial volume, SAD (as compared to control) subjects had greater GM in the left parahippocampal and middle occipital, and bilateral supramarginal and angular cortices, and left cerebellum; and lower GM in bilateral temporal poles and left lateral orbitofrontal cortex. Cerebellar, parahippocampal, and temporal pole differences were observed in both samples, survived whole brain corrections, and were not observed in the PD group, pointing to relative specificity to SAD. Conclusions These findings parallel the functional literature on SAD, and suggest structural abnormalities underlying the functional disturbances. PMID:22748614

  2. Clinical and academic profile of children with specific learning disorder-mixed type: An Indian study

    Directory of Open Access Journals (Sweden)

    Anamika Sahu

    2017-01-01

    Full Text Available Background: Specific learning disorder (SLD in the past decade has gained recognition as a disabling condition among children by parents and teachers in India. However, there are still gaps in knowledge about its clinical presentation and understanding. Therefore, the present study was planned to evaluate the clinical and academic profile of children with SLD. Methods: The sample comprised 30 children with their age range between 7 and 12 years with a diagnosis of SLD-mixed type. All children were assessed through specifically designed structured pro forma for clinical details (i.e., nature of birth, developmental milestones, and comorbidities and academic history (i.e., history of failure, promoted in next class, repetition in the class, school change, etc. and SLD-comprehensive battery. Results: The mean age of the participants was 9.6 years (standard deviation [SD] = 1.5. 76.7% of participants were male and their mean years of education was 4.7 (SD = 1.5. Thirty percent of children had a history of delayed developmental milestones in terms of speech (16.7%, walking (6.7% and in speech and walking (6.7%, 23% of children had comorbid conditions of attention-deficit/hyperactivity disorder/attention-deficit disorder. Thirty percent of children repeated classes in their academic career. Conclusions: A significant number of children had delayed milestones and other problems. Moreover, it is important to understand the clinical and academic profile in the cultural context so that early identification and intervention can be planned.

  3. Toward the Identification of a Specific Psychopathology of Substance Use Disorders

    Directory of Open Access Journals (Sweden)

    Angelo G. I. Maremmani

    2017-04-01

    Full Text Available Addiction is a mental illness in which psychiatric conditions imply a prominent burden. Psychopathological symptoms in substance use disorder (SUD patients are usually viewed as being assignable to the sphere of a personality trait or of comorbidity, leaving doubts about the presence of a specific psychopathology that could only be related to the toxicomanic process. Our research group at the University of Pisa has shed light on the possible definition of a specific psychopathological dimension in SUDs. In heroin use disorder patients, performing an exploratory principal component factor analysis (PCA on all the 90 items included in the SCL-90 questionnaire led to a five-factor solution. The first factor accounted for a depressive “worthlessness and being trapped” dimension; the second factor picked out a “somatic symptoms” dimension; the third identified a “sensitivity–psychoticism” dimension; the fourth a “panic–anxiety” dimension; and the fifth a “violence–suicide” dimension. These same results were replicated by applying the PCA to another Italian sample of 1,195 heroin addicts entering a Therapeutic Community Treatment. Further analyses confirmed the clusters of symptoms, independently of demographic and clinical characteristics, active heroin use, lifetime psychiatric problems, kind of treatment received, and, especially, other substances used by the patient such as alcohol or cocaine. Moreover, these clusters were able to discriminate patients affected by addiction from those affected by psychiatric diseases such as major depressive disorder. Our studies seem to suggest the trait-dependent, rather than the state-dependent, nature of the introduced psychopathology dimensions of SUDs.

  4. Different association between specific manifestations of bruxism and temporomandibular disorder pain.

    Science.gov (United States)

    Berger, Marcin; Szalewski, Leszek; Szkutnik, Jacek; Ginszt, Michał; Ginszt, Apolinary

    A growing body of evidence suggests that bruxism exists in two separate manifestations. However, little is known about the association between specific manifestations of bruxism and temporomandibular disorder (TMD) pain. The aim of our study was to analyze the association between TMD pain and specific diagnoses of bruxism (sleep, awake, and mixed diagnosis of sleep and awake bruxism). 508 adult patients (296 women and 212 men), aged between 18 and 64 years (mean age 34±12 years), attending to a clinic for general dental treatment. Patients were asked to fill an anonymous questionnaire, consisting of three questions, verifying the presence of TMD pain and two forms of bruxism. All questions were based on the Polish version of the Research Diagnostic Criteria for Temporomandibular Disorders patient history questionnaire. Cross tabulation was done, and χ 2 was used as a test of significance to find the association between the variables. Awake bruxism was associated with TMD pain only in men (χ 2 =7.746, pbruxism was associated with TMD pain in both women (χ 2 =10.486, pbruxism and TMD pain. Gender-related differences in the presence of all bruxism diagnoses were also statistically insignificant. Interaction between sleep and awake bruxism may increase the risk for TMD pain. We suggest considering concomitance as a confounder, when studying sleep or awake bruxism. Copyright © 2016 Polish Neurological Society. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

  5. Congenital amusia: a group study of adults afflicted with a music-specific disorder.

    Science.gov (United States)

    Ayotte, Julie; Peretz, Isabelle; Hyde, Krista

    2002-02-01

    The condition of congenital amusia, commonly known as tone-deafness, has been described for more than a century, but has received little empirical attention. In the present study, a research effort has been made to document in detail the behavioural manifestations of congenital amusia. A group of 11 adults, fitting stringent criteria of musical disabilities, were examined in a series of tests originally designed to assess the presence and specificity of musical disorders in brain-damaged patients. The results show that congenital amusia is related to severe deficiencies in processing pitch variations. The deficit extends to impairments in music memory and recognition as well as in singing and the ability to tap in time to music. Interestingly, the disorder appears specific to the musical domain. Congenital amusical individuals process and recognize speech, including speech prosody, common environmental sounds and human voices, as well as control subjects. Thus, the present study convincingly demonstrates the existence of congenital amusia as a new class of learning disabilities that affect musical abilities.

  6. Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care

    Science.gov (United States)

    DE HERT, MARC; CORRELL, CHRISTOPH U.; BOBES, JULIO; CETKOVICH-BAKMAS, MARCELO; COHEN, DAN; ASAI, ITSUO; DETRAUX, JOHAN; GAUTAM, SHIV; MÖLLER, HANS-JURGEN; NDETEI, DAVID M.; NEWCOMER, JOHN W.; UWAKWE, RICHARD; LEUCHT, STEFAN

    2011-01-01

    The lifespan of people with severe mental illness (SMI) is shorter compared to the general population. This excess mortality is mainly due to physical illness. We report prevalence rates of different physical illnesses as well as important individual lifestyle choices, side effects of psychotropic treatment and disparities in health care access, utilization and provision that contribute to these poor physical health outcomes. We searched MEDLINE (1966 – August 2010) combining the MeSH terms of schizophrenia, bipolar disorder and major depressive disorder with the different MeSH terms of general physical disease categories to select pertinent reviews and additional relevant studies through cross-referencing to identify prevalence figures and factors contributing to the excess morbidity and mortality rates. Nutritional and metabolic diseases, cardiovascular diseases, viral diseases, respiratory tract diseases, musculoskeletal diseases, sexual dysfunction, pregnancy complications, stomatognathic diseases, and possibly obesity-related cancers are, compared to the general population, more prevalent among people with SMI. It seems that lifestyle as well as treatment specific factors account for much of the increased risk for most of these physical diseases. Moreover, there is sufficient evidence that people with SMI are less likely to receive standard levels of care for most of these diseases. Lifestyle factors, relatively easy to measure, are barely considered for screening; baseline testing of numerous important physical parameters is insufficiently performed. Besides modifiable lifestyle factors and side effects of psychotropic medications, access to and quality of health care remains to be improved for individuals with SMI. PMID:21379357

  7. Male-specific deficits in natural reward learning in a mouse model of neurodevelopmental disorders

    NARCIS (Netherlands)

    Grissom, N M; McKee, S E; Schoch, H; Bowman, N; Havekes, R; O'Brien, W T; Mahrt, E; Siegel, S; Commons, K; Portfors, C; Nickl-Jockschat, T; Reyes, T M; Abel, T

    Neurodevelopmental disorders, including autism spectrum disorders, are highly male biased, but the underpinnings of this are unknown. Striatal dysfunction has been strongly implicated in the pathophysiology of neurodevelopmental disorders, raising the question of whether there are sex differences in

  8. Parental psychosocial attitudes and opinions on the use of psychotropic medication in mental disorders of childhood

    International Nuclear Information System (INIS)

    Abid, H.; Aadil, M.; Hamdani, S.U.

    2018-01-01

    To assess parental practices and attitude regarding administration of psychotropic agents in their children suffering from psychiatric disorders. Study Design: Cross sectional descriptive study. Place and Duration of Study: Psychiatry Out-Patient Department (OPD) Mayo Hospital conducted over a span of 6 months, from 15 Apr to 15 Oct 2017. Material and Methods: Ninety three individuals were included in the study through non-probability purposive sampling. Informed consent was taken from the parents. A closed ended questionnaire was designed to carry out a targeted survey which was focused on the knowledge and practices followed by parents during their first contact in an outpatient department. Parents were asked whether they believe that psychotropic drugs are effective in the treatment of mental disorders. Results: Results are based on ninety three responders who participated in answering the questionnaire. Eighty turned out and submitted the questionnaire for result compilation and analysis. Participants ranged from 19 to 65 years. Males outnumbered female's patients during the study period by approx, 20%. The study indicated that two third of the patients had family history of mental illness. Common diagnosis included epilepsy, behavioral/ conversion disorders and mental retardation. One thought-provoking finding among parents was that psychotropic drugs lead to certain side effects and somehow effects which may causes biological abnormalities resulting into several medical diseases. Others had a belief that these drugs are addictive and may cause vital organs failure. Conclusion: Mostly parents were of the opinion that are of psychotropic drugs lead to certain side effects and somehow effects brain which may cause biological abnormalities resulting into several medical diseases. (author)

  9. The neurocognition of conduct disorder behaviors: specificity to physical aggression and theft after controlling for ADHD symptoms

    NARCIS (Netherlands)

    Barker, E.D.; Tremblay, R.E.; van Lier, P.A.C.; Vitaro, F.; Nagin, D.S.; Assaad, J.M.; Seguin, J.R.

    2011-01-01

    There is growing evidence that among the different conduct disorder (CD) behaviors, physical aggression, but not theft, links to low neurocognitive abilities. Specifically, physical aggression has consistently been found to be negatively related to neurocognitive abilities, whereas theft has been

  10. Medication persistence with long-term, specific grass pollen immunotherapy measured by prescription renewal rates.

    Science.gov (United States)

    Sieber, J; De Geest, S; Shah-Hosseini, K; Mösges, R

    2011-04-01

    We assessed medication persistence using prescription renewal rates for grass pollen specific immunotherapy (SIT) in a representative population of patients in Germany to evaluate whether the perception of superior persistence for the subcutaneous route compared to the sublingual route could be confirmed in clinical practice. Individual prescriptions for allergen immunotherapy were extracted from a national prescription database (INSIGHT Health) and followed over 3 years on a per-patient basis. However, patients' medical history and treatment schedules were not available for analysis. Products were identified by the national drug code (PZN number) and grouped to either subcutaneous immunotherapy (SCIT) with natural extract injections, SCIT with modified allergens (allergoids) or sublingual immunotherapy (SLIT) with natural pollen extract solutions. Persistence was defined as at least one prescription of the individual drug in the respective years. A total of 1409 patients started SIT in 2005 (112, 695, and 602 for natural extract SLIT, natural extract SCIT, and allergoid SCIT, respectively). In 2006, 71%, 55%, and 59% of those patients had at least one renewal prescription of natural extract SLIT, natural extract SCIT, and allergoid SCIT, respectively, as well as 51%, 34%, and 39% in 2007. In both years, persistence with natural extract SLIT was significantly higher than with natural extract SCIT (p = 0.0015 for 2006, p = 0.0003 for 2007) and allergoid SCIT (p = 0.0152 for 2006, p = 0.0111 for 2007). There were no significant differences between the two SCIT groups. Medication persistence with grass pollen SIT in a representative sample of patients in Germany was similar to published medication persistence in asthma and COPD patients. The sublingual application route shows significantly better persistency than the subcutaneous route with native allergens or allergoids.

  11. Parent perspectives on the decision to initiate medication treatment of attention-deficit/hyperactivity disorder.

    Science.gov (United States)

    Coletti, Daniel J; Pappadopulos, Elizabeth; Katsiotas, Nikki J; Berest, Alison; Jensen, Peter S; Kafantaris, Vivian

    2012-06-01

    Despite substantial evidence supporting the efficacy of stimulant medication for children with attention-deficit/hyperactivity disorder (ADHD), adherence to stimulant treatment is often suboptimal. Applying social/cognitive theories to understanding and assessing parent attitudes toward initiating medication may provide insight into factors influencing parent decisions to follow ADHD treatment recommendations. This report describes results from formative research that used focus groups to obtain parent input to guide development of a provider-delivered intervention to improve adherence to stimulants. Participants were caregivers of children with ADHD who were given a stimulant treatment recommendation. Focus groups were recorded and transcribed verbatim. Data were analyzed by inductive, grounded theory methods as well as a deductive analytic strategy using an adapted version of the Unified Theory of Behavior Change to organize and understand parent accounts. Five groups were conducted with 27 parents (mean child age=9.35 years; standard deviation [SD]=2.00), mean time since diagnosis=3.33 years (SD=2.47). Most parents (81.5%) had pursued stimulant treatment. Inductive analysis revealed 17 attitudes facilitating adherence and 25 barriers. Facilitators included parent beliefs that medication treatment resulted in multiple functional gains and that treatment was imperative for their children's safety. Barriers included fears of personality changes and medication side effects. Complex patterns of parent adherence to medication regimens were also identified, as well as preferences for psychiatrists who were diagnostically expert, gave psychoeducation using multiple modalities, and used a chronic illness metaphor to explain ADHD. Theory-based analyses revealed conflicting expectancies about treatment risks and benefits, significant family pressures to avoid medication, guilt and concern that their children required medication, and distorted ideas about treatment risks

  12. Use of evidence-based assessments for childhood anxiety disorders within a regional medical system.

    Science.gov (United States)

    Sattler, Adam F; Ale, Chelsea M; Nguyen, Kristin; Gregg, Melissa S; Geske, Jennifer R; Whiteside, Stephen P H

    2016-11-01

    Anxiety disorders represent a common and serious threat to mental health in children and adolescents. To effectively treat anxiety in children, clinicians must conduct accurate assessment of patients' symptoms. However, despite the importance of assessment in the treatment of childhood anxiety disorders, the literature lacks a thorough analysis of the practices used by clinicians' when evaluating such disorders in community settings. Thus, the current study examines the quality of assessment for childhood anxiety disorders in a large regional health system. The results suggest that clinicians often provide non-specific diagnoses, infrequently document symptoms according to diagnostic criteria, and rarely administer rating scales and structured diagnostic interviews. Relatedly, diagnostic agreement across practice settings was low. Finally, the quality of assessment differed according to the setting in which the assessment was conducted and the complexity of the patient's symptomatology. These results highlight the need to develop and disseminate clinically feasible evidence-based assessment practices that can be implemented within resource-constrained service settings. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  13. Stigma associated with medication treatment for young adults with opioid use disorder: a case series.

    Science.gov (United States)

    Hadland, Scott E; Park, Tae Woo; Bagley, Sarah M

    2018-05-07

    Opioid-related overdose deaths have risen sharply among young adults. Despite this increase, access to evidence-based medication for opioid agonist treatment (OAT) for youth remains low. Among older adults, barriers to OAT include the paucity of buprenorphine-waivered prescribers and low rates of prescribing among waivered physicians. We have increasingly found in our clinical practice significant stigma related to using OAT to treat addiction for young adults. In this series, we describe three cases of young adults who faced significant stigma related to their treatment. The first case is a young male with a history of significant trauma and a severe opioid use disorder. He started buprenorphine and has found a job, stayed abstinent, and began a healthy relationship. At each step in his recovery, he has faced resistance to taking medication from other treatment providers, directors of sober houses, and his parents. The second case is a young woman who presented to a substance use treatment program after a relapse. She was unable to restart buprenorphine despite our calling to ask that it be restarted. Ultimately, she left against medical advice and was stabilized as an outpatient on buprenorphine. The final case is a young woman who stopped buprenorphine after being told she was "not sober" while attending 12-step group but restarted after conversations with her clinical team. In each case, the patient has continued their medication treatment and are stable. Opioid-related deaths continue to rise among all age groups, including young adults. Stigma related to medication treatment can be a substantial barrier for many young adult patients but there are concrete steps that providers and communities can take to address this stigma.

  14. Alcohol use disorders increase the risk for mechanical ventilation in medical patients.

    Science.gov (United States)

    de Wit, Marjolein; Best, Al M; Gennings, Chris; Burnham, Ellen L; Moss, Marc

    2007-07-01

    Annually, more than 300,000 patients receive mechanical ventilation in an intensive care unit in the United States. The hospital mortality for ventilated patients may approach 50%, depending on the primary diagnosis. In trauma and surgical patients, a diagnosis of alcohol use disorder (AUD) is common and is associated with a prolonged duration of mechanical ventilation. The objective of this study is to determine whether the presence of AUD and the development of alcohol withdrawal are associated with an increased use and duration of mechanical ventilation in patients with medical disorders that commonly require intensive care unit admission. We performed a retrospective cohort study using the Nationwide Inpatient Sample, a large all-payer inpatient database representing approximately 1,000 hospitals. For the years 2002 to 2003, adult patients with 1 of the 6 most common diagnoses associated with medical intensive care unit admission were included in the study. Both univariate analysis and multivariable logistic regression were performed to determine whether AUD and alcohol withdrawal were independently associated with the use and duration of mechanical ventilation in these patients. There were a total 785,602 patients who fulfilled 1 of the 6 diagnoses, 26,577 (3.4%) had AUD, 3,967 (0.5%) had alcohol withdrawal, and 65,071 (8.3%) underwent mechanical ventilation (53% or =96 hours). Independent of the medical diagnosis, AUD was associated with an increased risk of requiring mechanical ventilation (13.7 vs 8.1%, odds ratio=1.49, 95% confidence interval [1.414; 1.574], palcohol withdrawal was associated with a longer duration of mechanical ventilation (57 vs 47%> or =96 hours, odds ratio=1.48, 95% confidence interval [1.266; 1.724], palcohol withdrawal is associated with a longer duration of mechanical ventilation.

  15. State-Targeted Funding and Technical Assistance to Increase Access to Medication Treatment for Opioid Use Disorder.

    Science.gov (United States)

    Abraham, Amanda J; Andrews, Christina M; Grogan, Colleen M; Pollack, Harold A; D'Aunno, Thomas; Humphreys, Keith; Friedmann, Peter D

    2018-04-01

    As the United States grapples with an opioid epidemic, expanding access to effective treatment for opioid use disorder is a major public health priority. Identifying effective policy tools that can be used to expand access to care is critically important. This article examines the relationship between state-targeted funding and technical assistance and adoption of three medications for treating opioid use disorder: oral naltrexone, injectable naltrexone, and buprenorphine. This study draws from the 2013-2014 wave of the National Drug Abuse Treatment System Survey, a nationally representative, longitudinal study of substance use disorder treatment programs. The sample includes data from 695 treatment programs (85.5% response rate) and representatives from single-state agencies in 49 states and Washington, D.C. (98% response rate). Logistic regression was used to examine the relationships of single-state agency targeted funding and technical assistance to availability of opioid use disorder medications among treatment programs. State-targeted funding was associated with increased program-level adoption of oral naltrexone (adjusted odds ratio [AOR]=3.14, 95% confidence interval [CI]=1.49-6.60, p=.004) and buprenorphine (AOR=2.47, 95% CI=1.31-4.67, p=.006). Buprenorphine adoption was also correlated with state technical assistance to support medication provision (AOR=1.18, 95% CI=1.00-1.39, p=.049). State-targeted funding for medications may be a viable policy lever for increasing access to opioid use disorder medications. Given the historically low rates of opioid use disorder medication adoption in treatment programs, single-state agency targeted funding is a potentially important tool to reduce mortality and morbidity associated with opioid disorders and misuse.

  16. [Voxel-Based Morphometry in Medicated-naive Boys with Attention-deficit/hyperactivity Disorder(ADHD)].

    Science.gov (United States)

    Liu, Qi; Chen, Lizhou; Li, Fei; Chen, Ying; Guo, Lanting; Gong, Qiyong; Huang, Xiaoqi

    2016-06-01

    Attention-deficit/hyperactivity disorder(ADHD)is one of the most common neuro-developmental disorders occurring in childhood,characterized by symptoms of age-inappropriate inattention,hyperactivity/impulsivity,and the prevalence is higher in boys.Although gray matter volume deficits have been frequently reported for ADHD children via structural magnetic resonance imaging,few of them had specifically focused on male patients.The present study aimed to explore the alterations of gray matter volumes in medicated-naive boys with ADHD via a relatively new voxel-based morphometry technique.According to the criteria of DSM-IV-TR,43medicated-naive ADHD boys and 44age-matched healthy boys were recruited.The magnetic resonance image(MRI)scan was performed via a 3T MRI system with three-dimensional(3D)spoiled gradient recalled echo(SPGR)sequence.Voxel-based morphometry with diffeomorphic anatomical registration through exponentiated lie algebra in SPM8 was used to preprocess the3DT1-weighted images.To identify gray matter volume differences between the ADHD and the controls,voxelbased analysis of whole brain gray matter volumes between two groups were done via two sample t-test in SPM8 with age as covariate,threshold at P<0.001.Finally,compared to the controls,significantly reduced gray matter volumes were identified in the right orbitofrontal cortex(peak coordinates[-2,52,-25],t=4.01),and bilateral hippocampus(Left:peak coordinates[14,0,-18],t=3.61;Right:peak coordinates[-14,15,-28],t=3.64)of ADHD boys.Our results demonstrated obvious reduction of whole brain gray matter volumes in right orbitofrontal cortex and bilateral hippocampus in boys with ADHD.This suggests that the abnormalities of prefrontal-hippocampus circuit may be the underlying cause of the cognitive dysfunction and abnormal behavioral inhibition in medicatednaive boys with ADHD.

  17. Marriage as a Risk Factor for Internalizing Disorders: Clarifying Scope and Specificity

    Science.gov (United States)

    Brock, Rebecca L.; Lawrence, Erika

    2011-01-01

    Objective Marital discord has been linked to both depression and anxiety; however, our understanding of how marriage contributes to the development of internalizing symptoms is limited in scope and lacking specificity. First, it is unclear whether the marital relationship contributes to the broad dimension of internalizing symptoms as opposed to specific diagnoses. Second, it is unclear how the marital relationship contributes to internalizing symptoms: through global marital dissatisfaction or through specific relationship processes (and which processes). The purpose of the present study was to address these two issues and, more generally, to develop a comprehensive and refined framework within which to understand the role of marriage in the developmental course of internalizing symptoms. Method Questionnaire and interview data were collected from 102 husbands and wives 5 times over the first 7 years of marriage. Results Results indicated that marital discord during the transition into marriage was associated with the broad dimension of internalizing symptoms for husbands but not for wives. Further, both global marital dissatisfaction and an imbalance of power and control put husbands at significant risk for symptoms over the first 7 years of marriage, whereas low levels of emotional intimacy put wives at significant risk. Conclusions Results exemplify the need to routinely consider intimate relationship processes in etiological models of depression and anxiety, and identify specific clinical targets that can be prioritized in interventions aimed at preventing internalizing disorders. PMID:21823784

  18. Marriage as a risk factor for internalizing disorders: clarifying scope and specificity.

    Science.gov (United States)

    Brock, Rebecca L; Lawrence, Erika

    2011-10-01

    Marital discord has been linked to both depression and anxiety; however, our understanding of how marriage contributes to the development of internalizing symptoms is limited in scope and lacking specificity. First, it is unclear whether the marital relationship contributes to the broad dimension of internalizing symptoms as opposed to specific diagnoses. Second, it is unclear how the marital relationship contributes to internalizing symptoms: through global marital dissatisfaction or through specific relationship processes (and which processes). The purpose of the present study was to address these 2 issues and, more generally, to develop a comprehensive and refined framework within which to understand the role of marriage in the developmental course of internalizing symptoms. Questionnaire and interview data were collected from 102 husbands and wives 5 times over the first 7 years of marriage. Results indicated that marital discord during the transition into marriage was associated with the broad dimension of internalizing symptoms for husbands but not for wives. Further, both global marital dissatisfaction and an imbalance of power and control put husbands at significant risk for symptoms over the first 7 years of marriage, whereas low levels of emotional intimacy put wives at significant risk. Results exemplify the need to routinely consider intimate relationship processes in etiological models of depression and anxiety and to identify specific clinical targets that can be prioritized in interventions aimed at preventing internalizing disorders.

  19. Paediatricians' decision making about prescribing stimulant medications for children with attention-deficit/hyperactivity disorder.

    Science.gov (United States)

    Chow, S-J; Sciberras, E; Gillam, L H; Green, J; Efron, D

    2014-05-01

    Attention-deficit/hyperactivity disorder (ADHD) is now the most common reason for a child to present to a paediatrician in Australia. Stimulant medications are commonly prescribed for children with ADHD, to reduce symptoms and improve function. In this study we investigated the factors that influence paediatricians' decisions about prescribing stimulant medications. In-depth, semi-structured interviews were conducted with paediatricians (n = 13) who were purposively recruited so as to sample a broad demographic of paediatricians working in diverse clinical settings. Paediatricians were recruited from public outpatient and private paediatrician clinics in Victoria, Australia. The interviews were audio-recorded and transcribed verbatim for thematic analysis. Paediatricians also completed a questionnaire describing their demographic and practice characteristics. Our findings showed that the decision to prescribe is a dynamic process involving two key domains: (1) weighing up clinical factors; and (2) interacting with parents and the patient along the journey to prescribing. Five themes relating to this process emerged from data analysis: comprehensive assessments that include history, examination and information from others; influencing factors such as functional impairment and social inclusion; previous success; facilitating parental understanding including addressing myths and parental confusion; and decision-making model. Paediatricians' decisions to prescribe stimulant medications are influenced by multiple factors that operate concurrently and interdependently. Paediatricians do not make decisions about prescribing in isolation; rather, they actively involve parents, teachers and patients, to arrive at a collective, well-informed decision. © 2013 John Wiley & Sons Ltd.

  20. Use of automated medication adherence monitoring in bipolar disorder research: pitfalls, pragmatics, and possibilities.

    Science.gov (United States)

    Levin, Jennifer B; Sams, Johnny; Tatsuoka, Curtis; Cassidy, Kristin A; Sajatovic, Martha

    2015-04-01

    Medication nonadherence occurs in 20-60% of persons with bipolar disorder (BD) and is associated with serious negative outcomes, including relapse, hospitalization, incarceration, suicide and high healthcare costs. Various strategies have been developed to measure adherence in BD. This descriptive paper summarizes challenges and workable strategies using electronic medication monitoring in a randomized clinical trial (RCT) in patients with BD. Descriptive data from 57 nonadherent individuals with BD enrolled in a prospective RCT evaluating a novel customized adherence intervention versus control were analyzed. Analyses focused on whole group data and did not assess intervention effects. Adherence was assessed with the self-reported Tablets Routine Questionnaire and the Medication Event Monitoring System (MEMS). The majority of participants were women (74%), African American (69%), with type I BD (77%). Practical limitations of MEMS included misuse in conjunction with pill minders, polypharmacy, cost, failure to bring to research visits, losing the device, and the device impacting baseline measurement. The advantages were more precise measurement, less biased recall, and collecting data from past time periods for missed interim visits. Automated devices such as MEMS can assist investigators in evaluating adherence in patients with BD. Knowing the anticipated pitfalls allows study teams to implement preemptive procedures for successful implementation in BD adherence studies and can help pave the way for future refinements as automated adherence assessment technologies become more sophisticated and readily available.

  1. Anxiety in Medically Ill Children/Adolescents

    OpenAIRE

    Pao, Maryland; Bosk, Abigail

    2010-01-01

    Anxiety disorders are thought to be one of the most common psychiatric diagnoses in children/adolescents. Chronic medical illness is a significant risk factor for the development of an anxiety disorder and the prevalence rate of anxiety disorders among youths with chronic medical illnesses is higher compared to their healthy counterparts. Anxiety disorders may develop secondary to predisposing biological mechanisms related to a child’s specific medical illness, as a response to being ill or i...

  2. Need and Perspectives of Internet-based Interventions for Common Specific language Disorders and Connected Specific Learning Disabilities in Childhood and Youth

    OpenAIRE

    Haverkamp, F.; Mohamad, Y.

    2015-01-01

    In the last century medical progress has substantially reduced the morbidity and mortality in somatic diseases. However there is a new morbidity with an increase of psychomotor developmental, learning, behavioral and mental disorders often with an initial onset in about 20% of childhood. A social gradient in terms of health inequalities is known. Reducing this new morbidity of child and adolescent health problems is a major public health priority. In this context alternative, complementary st...

  3. Comparison of a Broad-Based Screen versus Disorder-Specific Screen in Detecting Young Children with an Autism Spectrum Disorder

    OpenAIRE

    Wiggins, Lisa D.; Piazza, Vivian; Robins, Diana L.

    2012-01-01

    The goals of our study were to (a) compare agreement between autism spectrum disorder diagnosis and outcome of the Modified Checklist for Autism in Toddlers and Parents Evaluation of Developmental Status in a sample of toddlers and (b) examine specific concerns noted for toddlers who screened negative on the Modified Checklist for Autism in Toddlers or Parents Evaluation of Developmental Status but were later diagnosed with autism spectrum disorder. Participants were administered the Modified...

  4. Depression in the Context of Medical Disorders: New Pharmacological Pathways Revisited

    Directory of Open Access Journals (Sweden)

    Undine E. Lang

    2017-10-01

    Full Text Available The depressive state has been characterised as one of elevated inflammation, changed cardiovascular parameters and a deranged metabolic situation all of which holds promise for a better understanding and handling of treatment-resistance in affective disorders as well as for future developments in treatment algorithms. In this context several biomarkers are differentially regulated by antidepressant treatment and connected to metabolic, inflammatory, cardiovascular and apoptotic components of the pathophysiology, i.e. adiponectin, apolipoprotein-B, B-type natriuretic peptide, cortisol, CRP, cysteine, homocysteine, fibrinogen, adiponectin, BMI, glycated hemoglobin A1c, leptin, interferon-gamma, high-density lipoprotein, interleukin interleukin-1alpha, -1beta, -2, -4, -5, -6, -8, -10, -12, -13, -17, insulin-like growth factor-1, low-density lipoprotein, myeloperoxidase, osteoprotegerin, tumour necrosis factor alpha, troponins, triglycerides etc. In this context antidepressants exert different modulatory effects on the outcome, incidence and mortality concerning several severe disorders, i.e. cancer, diabetes, stroke, inflammation, stroke and cardiovascular risk. Vice versa different drugs used in the treatment of these disorders have a favourable effect in depressive states, e.g. statins, aspirine, NSAIDs, pioglitazone, celecoxib, peroxisome proliferator-activated receptor-gamma agonists and minocycline. In this review, actions of different antidepressant treatment strategies on cancer, stroke, diabetes and cardiovascular disorders are shown and the influence on the outcome of the disorders is differentially discussed. In conclusion a hypothetic model for the implication of actual findings in everyday clinical practice is proposed. In this context personalized treatment could be used to tailor treatment to specific individuals according to their clinical endophenotypes. Moreover a potential target for the development of novel intervention

  5. Source-Specific Oppositional Defiant Disorder among Inner-City Children: Prospective Prediction and Moderation

    Science.gov (United States)

    Drabick, Deborah A. G.; Bubier, Jennifer; Chen, Diane; Price, Julia; Lanza, H. Isabella

    2011-01-01

    We examined prospective prediction from parent- and teacher-reported oppositional defiant disorder (ODD) symptoms to parent-reported ODD, conduct disorder (CD), major depressive disorder (MDD), and generalized anxiety disorder symptoms and whether child executive functioning abilities moderated these relations among an urban, low-income sample of…

  6. Cognitive Risk Factors for Specific Learning Disorder: Processing Speed, Temporal Processing, and Working Memory

    Science.gov (United States)

    Moll, Kristina; Göbel, Silke M.; Gooch, Debbie; Landerl, Karin; Snowling, Margaret J.

    2016-01-01

    High comorbidity rates between reading disorder (RD) and mathematics disorder (MD) indicate that, although the cognitive core deficits underlying these disorders are distinct, additional domain-general risk factors might be shared between the disorders. Three domain-general cognitive abilities were investigated in children with RD and MD:…

  7. [Validity of a standard questionnaire to assess physical activity for specific medical checkups and health guidance].

    Science.gov (United States)

    Kawakami, Ryoko; Miyachi, Motohiko

    2010-10-01

    This study aimed to determine the validity of a standard questionnaire to assess amount of physical activity (PA) and cardiorespiratory fitness (VO2peak). A total of 483 men and women, aged 20 to 69 years, participated. The standard questionnaire included 3 items about exercise, PA, and walking speed. All questions were designed to require an answer of Yes or No. Subjects were classified into one of four groups regarding the number of Yes answers to the three questions, giving activity levels of 0 to 3. The amount of PA was measured objectively with a tn-axial accelerometer which could also calculate daily step counts, and the amounts of PA under 3 metabolic equivalents (METs) and at 3 METs or more. VO2peak. was measured by incremental cycle exercise tests with indirect calorimetry. The daily step counts, the amount of PA at 3 METs or more, and the VO2peak. were significantly higher in subjects who answered Yes to each question than in those who answered No. Sensitivity and specificity of each question were 62-73% and 45-71% for the amount of PA established with the "Exercise and Physical Activity Reference for Health Promotion 2006 (EPAR2006)". The sum of sensitivity and specificity was the highest when the cutoff value was activity level 2 (sensitivity 73%, specificity 68%). Sensitivity and specificity for VO2max established by EPAR2006 were lower than those for the amount of PA. These results suggest that only answering simple questions with a standard questionnaire is sufficient for estimation of PA levels for specific medical checkups and health guidance, even though the accuracy is somewhat limited.

  8. Systematic Review of Patient-Specific Surgical Simulation: Toward Advancing Medical Education.

    Science.gov (United States)

    Ryu, Won Hyung A; Dharampal, Navjit; Mostafa, Ahmed E; Sharlin, Ehud; Kopp, Gail; Jacobs, William Bradley; Hurlbert, Robin John; Chan, Sonny; Sutherland, Garnette R

    Simulation-based education has been shown to be an effective tool to teach foundational technical skills in various surgical specialties. However, most of the current simulations are limited to generic scenarios and do not allow continuation of the learning curve beyond basic technical skills to prepare for more advanced expertise, such as patient-specific surgical planning. The objective of this study was to evaluate the current medical literature with respect to the utilization and educational value of patient-specific simulations for surgical training. We performed a systematic review of the literature using Pubmed, Embase, and Scopus focusing on themes of simulation, patient-specific, surgical procedure, and education. The study included randomized controlled trials, cohort studies, and case-control studies published between 2005 and 2016. Two independent reviewers (W.H.R. and N.D) conducted the study appraisal, data abstraction, and quality assessment of the studies. The search identified 13 studies that met the inclusion criteria; 7 studies employed computer simulations and 6 studies used 3-dimensional (3D) synthetic models. A number of surgical specialties evaluated patient-specific simulation, including neurosurgery, vascular surgery, orthopedic surgery, and interventional radiology. However, most studies were small in size and primarily aimed at feasibility assessments and early validation. Early evidence has shown feasibility and utility of patient-specific simulation for surgical education. With further development of this technology, simulation-based education may be able to support training of higher-level competencies outside the clinical settingto aid learners in their development of surgical skills. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  9. Immune responses to Epstein-Barr virus in individuals with systemic and organ specific autoimmune disorders

    Directory of Open Access Journals (Sweden)

    Kannangai R

    2010-01-01

    Full Text Available Purpose: Autoimmune diseases usually manifest in genetically predisposed individuals following an environmental trigger. There are several viral infections including Epstein-Barr virus (EBV implicated in the pathogenesis of autoimmune disorders. The aim of this study was to look at the antibody pattern to EBV proteins in the plasma of both systemic and organ specific autoimmune disorders, estimate pro-inflammatory plasma cytokines (IL-8 and TNF-α among these autoimmune patients and compare the observations with those in normal healthy controls. Materials and Methods: Samples from 44 rheumatoid arthritis patients, 25 Hashimoto′s thyroiditis patients, appropriately age and sex matched healthy controls were tested for EBV IgM antibodies by an immunoblot assay and two cytokines (IL-8 and TNF-α by commercial assays. Results: Among the rheumatoid arthritis patients, 23 (52% were positive for EBNA1 antibody, while 13 (52% of the Hashimoto′s thyroiditis patients and 12 (30% of the healthy controls showed similar bands. The intensity of the bands was high in the autoimmune patients when compared to the bands seen in control samples. The difference in the EBNA1 reactivity between rheumatoid arthritis patients and controls were significant (P = 0.038. There was a significant difference in the IgM reactivity to VCAp19 protein between patients and controls (P = 0.011. Conclusion: Our study showed an increased EBV activation among the autoimmune patient groups compared to the normal healthy controls. Further studies are required to delineate the association between the aetiology of autoimmune disorders and EBV.

  10. 47 CFR 95.1119 - Specific requirements for wireless medical telemetry devices operating in the 608-614 MHz band.

    Science.gov (United States)

    2010-10-01

    ... devices operating in the 608-614 MHz band. For a wireless medical telemetry device operating within the... 47 Telecommunication 5 2010-10-01 2010-10-01 false Specific requirements for wireless medical telemetry devices operating in the 608-614 MHz band. 95.1119 Section 95.1119 Telecommunication FEDERAL...

  11. 47 CFR 95.1121 - Specific requirements for wireless medical telemetry devices operating in the 1395-1400 and 1427...

    Science.gov (United States)

    2010-10-01

    ... wireless medical telemetry devices operating in the 1395-1400 and 1427-1432 MHz bands. Due to the critical... 47 Telecommunication 5 2010-10-01 2010-10-01 false Specific requirements for wireless medical telemetry devices operating in the 1395-1400 and 1427-1432 MHz bands. 95.1121 Section 95.1121...

  12. Comorbidity in youth with specific phobias: Impact of comorbidity on treatment outcome and the impact of treatment on comorbid disorders.

    Science.gov (United States)

    Ollendick, Thomas H; Ost, Lars-Göran; Reuterskiöld, Lena; Costa, Natalie

    2010-09-01

    The purpose of the present study was twofold. In an analysis of data from an existing randomized control trial of brief cognitive behavioral treatment on specific phobias (One-Session Treatment, OST; Ollendick et al., 2009), we examined 1) the effect of comorbid specific phobias and other anxiety disorders on treatment outcomes, and 2) the effect of treatment of the specific phobia on these co-occurring disorders. These relations were explored in 100 youth presenting with animal, natural environment, situational, and "other" types of phobia. Youth were reliably diagnosed with the Anxiety Disorders Interview Schedule for DSM-IV: Child and Parent versions (Silverman & Albano, 1996). Clinician severity ratings at post-treatment and 6-month follow-up were examined as were parent and child treatment outcome satisfaction measures. Results indicated that the presence of comorbid phobias or anxiety disorders did not affect treatment outcomes; moreover, treatment of the targeted specific phobias led to significant reductions in the clinical severity of other co-occurring specific phobias and related anxiety disorders. These findings speak to the generalization of the effects of this time-limited treatment approach. Implications for treatment of principal and comorbid disorders are discussed, and possible mechanisms for these effects are commented upon. 2010 Elsevier Ltd. All rights reserved.

  13. Chronic medical conditions and mental health in older people : disability and psychosocial resources mediate specific mental health effects

    NARCIS (Netherlands)

    Ormel, J; Kempen, GIJM; Penninx, BWJH; Brilman, EI; Beekman, ATF; VanSonderen, E

    Background. This study describes the differences in psychological distress, disability and psychosocial resources between types of major medical conditions and sensory impairments (collectively denoted as CMCs); and tests whether disability and psychosocial resources mediate CMC-specific mental

  14. Help-seeking beliefs for mental disorders among medical and nursing students.

    Science.gov (United States)

    Picco, Louisa; Seow, Esmond; Chua, Boon Yiang; Mahendran, Rathi; Verma, Swapna; Xie, Huiting; Wang, Jia; Chong, Siow Ann; Subramaniam, Mythily

    2018-05-09

    The current study aimed to investigate beliefs about help-seeking, treatment options and expected outcomes for people with alcohol abuse, dementia, depression, obsessive-compulsive disorder and schizophrenia, using a vignette-based approach, among a sample of nursing and medical students. This was a cross-sectional online study among medical and nursing students (n = 1002) who were randomly assigned 1 of 5 vignettes. Questions were asked about whom could best help the person in the vignette, the likely helpfulness of a broad range of interventions, and the likely outcome for the person in the vignette with and without appropriate help. A total of 45.1% of students recommended seeing a psychiatrist, which was the most common source of help reported for all 5 vignettes. Help-seeking preferences were significantly associated with age, academic year and vignette type. Respondents rated seeing a psychiatrist as the most helpful intervention (92.4%) and dealing with the problem on their own as the most harmful (68.1%). Then, 81.5% of students indicated that the condition of the person in the vignette would worsen if appropriate help was not sought. Medical and nursing students most commonly recommended seeking help from a psychiatrist for mental health-related problems, where help-seeking preferences were associated with various age, academic year and vignette type. As these students will be the future medical and nursing workforce, they need to be equipped with the skills and ability to recognize signs and symptoms of mental illness, to aid timely and appropriate treatment for people with mental illness. © 2018 The Authors Early Intervention in Psychiatry Published by John Wiley & Sons Australia, Ltd.

  15. Quality specifications in postgraduate medical e-learning: an integrative literature review leading to a postgraduate medical e-learning model.

    Science.gov (United States)

    De Leeuw, R A; Westerman, Michiel; Nelson, E; Ket, J C F; Scheele, F

    2016-07-08

    E-learning is driving major shifts in medical education. Prioritizing learning theories and quality models improves the success of e-learning programs. Although many e-learning quality standards are available, few are focused on postgraduate medical education. We conducted an integrative review of the current postgraduate medical e-learning literature to identify quality specifications. The literature was thematically organized into a working model. Unique quality specifications (n = 72) were consolidated and re-organized into a six-domain model that we called the Postgraduate Medical E-learning Model (Postgraduate ME Model). This model was partially based on the ISO-19796 standard, and drew on cognitive load multimedia principles. The domains of the model are preparation, software design and system specifications, communication, content, assessment, and maintenance. This review clarified the current state of postgraduate medical e-learning standards and specifications. It also synthesized these specifications into a single working model. To validate our findings, the next-steps include testing the Postgraduate ME Model in controlled e-learning settings.

  16. Risk of amphetamine use disorder and mortality among incident users of prescribed stimulant medications in the Veterans Administration.

    Science.gov (United States)

    Westover, Arthur N; Nakonezny, Paul A; Halm, Ethan A; Adinoff, Bryon

    2018-05-01

    Non-medical use of prescribed stimulant medications is a growing concern. This study's aims were to ascertain the demographics of stimulant medication users compared with non-users, examine temporal trends of stimulant medication use and estimate risk factors for development of amphetamine use disorder (AUD) and mortality among new users of stimulant medications. Cox proportional hazards regression in a retrospective cohort adjusted by baseline covariates. United States, national administrative database of the Veterans Affairs (VA) health-care system. Adult incident users of stimulant medications (n = 78 829) from fiscal years (FY) 2001 to 2012. Primary outcomes were time-to-event: (1) occurrence of AUD diagnosis and (2) death. Baseline covariates included demographic information, Food and Drug Administration (FDA)-approved indications for stimulant use, substance use disorders (SUD) and depression. Stimulant users compared with non-users were younger, more likely to be non-Hispanic white and female. Incident stimulant medication users increased threefold from FY2001-FY2012 and eightfold among adults aged 18-44 years. Nearly one in 10 incident users in FY2012 had a comorbid baseline SUD. Off-label use was common-nearly three of every five incident users in FY2012. Comorbid SUDs among incident stimulant medication users were risk factors for occurrence of AUD during follow-up, with adjusted hazard ratio (AHR) estimates ranging from 1.54 to 2.83 (Ps users in the Veterans Affairs health-care system, measured from fiscal years 2001 to 2012, comorbid substance use disorders were common and were risk factors for development of an amphetamine use disorder (AUD). Increased mortality risk among incident users of stimulant medications was observed among both those who developed an AUD later and those whose use was defined as off-label. © 2017 Society for the Study of Addiction.

  17. Effects of Motivation and Medication on Electrophysiological Markers of Response Inhibition in Children with Attention-Deficit/Hyperactivity Disorder

    OpenAIRE

    Groom, Madeleine J.; Scerif, Gaia; Liddle, Peter F.; Batty, Martin J.; Liddle, Elizabeth B.; Roberts, Katherine L.; Cahill, John D.; Liotti, Mario; Hollis, Chris

    2010-01-01

    Background Theories of attention-deficit/hyperactivity disorder (ADHD) posit either executive deficits and/or alterations in motivational style and reward processing as core to the disorder. Effects of motivational incentives on electrophysiological correlates of inhibitory control and relationships between motivation and stimulant medication have not been explicitly tested. Methods Children (9?15 years) with combined-type ADHD (n = 28) and matched typically developing children (CTRL) (n = 28...

  18. Content specificity of attentional bias to threat in post-traumatic stress disorder.

    Science.gov (United States)

    Zinchenko, A; Al-Amin, M M; Alam, M M; Mahmud, W; Kabir, N; Reza, H M; Burne, T H J

    2017-08-01

    Attentional bias to affective information and reduced cognitive control may maintain the symptoms of post-traumatic stress disorder (PTSD) and impair cognitive functioning. However, the role of content specificity of affective stimuli (e.g., trauma-related, emotional trauma-unrelated) in the observed attentional bias and cognitive control is less clear, as this has not been tested simultaneously before. Therefore, we examined the content specificity of attentional bias to threat in PTSD. PTSD participants (survivors of a multistory factory collapse, n=30) and matched controls (n=30) performed an Eriksen Flanker task. They identified the direction of a centrally presented target arrow, which was flanked by several task-irrelevant distractor arrows pointed to the same (congruent) or opposite direction (incongruent). Additionally, participants were presented with a picture of a face (neutral, emotional) or building (neutral=normal, emotional=collapsed multistory factory) as a task-irrelevant background image. We found that PTSD participants produced overall larger conflict effects and longer reaction times (RT) to emotional than to neutral stimuli relative to their healthy counterparts. Moreover, PTSD, but not healthy participants showed a stimulus specific dissociation in processing emotional stimuli. Emotional faces elicited longer RTs compared to neutral faces, while emotional buildings elicited faster responses, compared to neutral buildings. PTSD patients show a content-sensitive attentional bias to emotional information and impaired cognitive control. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. Personality and Defense Styles: Clinical Specificities and Predictive Factors of Alcohol Use Disorder in Women.

    Science.gov (United States)

    Ribadier, Aurélien; Dorard, Géraldine; Varescon, Isabelle

    2016-01-01

    This study investigated personality traits and defense styles in order to determine clinical specificities and predictive factors of alcohol use disorders (AUDs) in women. A female sample, composed of AUD outpatients (n = 48) and a control group (n = 50), completed a sociodemographic self-report and questionnaires assessing personality traits (BFI), defense mechanisms and defense styles (DSQ-40). Comparative and correlational analyses, as well as univariate and multivariate logistic regressions, were performed. AUD women presented with higher neuroticism and lower extraversion and conscientiousness. They used less mature and more neurotic and immature defense styles than the control group. Concerning personality traits, high neuroticism and lower conscientiousness were predictive of AUD, as well as low mature, high neurotic, and immature defense styles. Including personality traits and defense styles in a logistic model, high neuroticism was the only AUD predictive factor. AUD women presented clinical specificities and predictive factors in personality traits and defense styles that must be taken into account in AUD studies. Implications for specific treatment for women are discussed.

  20. Selective attention to imagined facial ugliness is specific to body dysmorphic disorder.

    Science.gov (United States)

    Grocholewski, Anja; Kliem, Sören; Heinrichs, Nina

    2012-03-01

    Cognitive-behavioral models postulate that biases in selective attention are key factors contributing to susceptibility to and maintenance of body dysmorphic disorder (BDD). Visual attention in particular toward the imagined defect in appearance may be a crucial element. The present study therefore examined whether individuals with BDD showed increased visual attention to flaws in their own and in unfamiliar faces. Twenty individuals with BDD, 20 individuals with social phobia, and 20 mentally healthy individuals participated in an eye-tracking experiment. Participants were instructed to gaze at the photographs of 15 pictures of themselves and several unfamiliar faces. Only patients with BDD showed heightened selective visual attention to the imagined defect in their own face, as well to corresponding regions in other, unfamiliar faces. The results support the assumption that there is a specific attentional bias in BDD. Copyright © 2012 Elsevier Ltd. All rights reserved.

  1. Subgroup-specific intrinsic disorder profiles of arabidopsis NAC transcription factors

    DEFF Research Database (Denmark)

    Stender, Emil G.; O'Shea, Charlotte; Skriver, Karen

    2015-01-01

    disordered but contain short, functionally important regions with structure propensities known as molecular recognition features. Here, we analyze for NAC subgroup-specific ID patterns. Some subgroups, such as the VND subgroup implicated in secondary cell wall biosynthesis, and the NAP/SHYG subgroup have...... highly conserved ID profiles. For the stress-associated ATAF1 subgroup and the CUC/ORE1 subgroup involved in development, only sub clades have similar ID patterns. For similar ID profiles, conserved molecular recognition features and sequence motifs represent likely functional determinants of e.......g. transcriptional activation and interactions. Based on our analysis, we suggest that ID profiling of regulatory proteins in general can be used to guide identification of interaction partners of network proteins....

  2. Increased Postdeployment Use of Medication for Common Mental Disorders in Danish Gulf War Veterans

    DEFF Research Database (Denmark)

    Nissen, Lars Ravnborg; Stoltenberg, Christian Ditlev Gabriel; Vedtofte, Mia Sadowa

    2017-01-01

    BACKGROUND: Gulf War veterans (GWVs) have an elevated risk of reporting symptoms of mental disorders as compared with nondeployed military controls. A difficulty in the Gulf War health research is that most health outcomes are self-reported; therefore, it is highly relevant to study objective....../hypnotic medication, and (3) number of postdeployment psychiatric contacts. The association between outcomes and GWVs status was studied by using time-to-event analysis. The index date was the return date from the last deployment to the Gulf. The follow-up period was the time from index date until December 31, 2014...... and anxiolytic or hypnotic medicine among GWVs compared with NVs were rather surprising since we recently, by using the same study population, found that deployment to the Persian Gulf was not associated with increased sickness absence or reduced labor market attachment. However, our results indicate...

  3. Neurasthenia, Generalized Anxiety Disorder, and the Medicalization of Worry in a Vietnamese Psychiatric Hospital.

    Science.gov (United States)

    Tran, Allen L

    2017-06-01

    This article examines two forms of the medicalization of worry in an outpatient psychiatric clinic in Ho Chi Minh City, Vietnam. Biomedical psychiatrists understand patients' symptoms as manifestations of the excessive worry associated with generalized anxiety disorder (GAD). Drawing on an ethnopsychology of emotion that reflects increasingly popular models of neoliberal selfhood, these psychiatrists encourage patients to frame psychic distress in terms of private feelings to address the conditions in their lives that lead to chronic anxiety. However, most patients attribute their symptoms to neurasthenia instead of GAD. Differences between doctors' and patients' explanatory models are not just rooted in their understandings of illness but also in their respective conceptualizations of worry in terms of emotion and sentiment. Patients with neurasthenia reject doctors' attempts to psychologize distress and maintain a model of worry that supports a sense of moral selfhood based on notions of obligation and sacrifice. © 2016 by the American Anthropological Association.

  4. [A historical medical study of post-traumatic stress disorders in World War I soldiers].

    Science.gov (United States)

    Lemke, S

    2007-01-01

    The concept of post-traumatic stress disorder (PTSD) was to be verified considering World War I soldiers suffering from psychiatric and neurologic diseases. According to hypotheses, relevant circumstances of the case history and significance of the direct military action had to be examined. In 2002, medical histories dating from 1914 to 1921 of male soldiers in Jena, Germany, were analyzed. Statistical examination carried out by means of the chi2 test revealed mental illness more frequently in soldiers with relevant family anamnesis, previous psychiatric treatment, or degree of voluntariness than in soldiers not so characterized. The accumulation of mental illnesses was lower in soldiers involved in military actions or directly with firing weapons than in soldiers never involved in battles. These results are in accord with historical but not current literature on PTSD. The author is of the opinion that psychiatric anamnesis is not given enough consideration in the concept of PTSD.

  5. A Study of the Impact of Cannabis on Doses of Discharge Antipsychotic Medication in Individuals with Schizophrenia or Schizoaffective Disorder.

    Science.gov (United States)

    Babatope, Taiwo; Chotalia, Jigar; Elkhatib, Rania; Mohite, Satyajit; Shah, Joel; Goddu, Sumana; Patel, Ruchir Arvind; Aimienwanu, Osarhiemen Ruth; Patel, Devanshu; Makanjuola, Titilayo; Okusaga, Olaoluwa O

    2016-12-01

    Patients with schizophrenia or schizoaffective disorder have a high prevalence of comorbid cannabis use disorder (CUD). CUD has been associated with poorer outcomes in patients. We compared doses of antipsychotic medications at the time of discharge from hospital among inpatients with schizophrenia or schizoaffective disorder with or without concurrent cannabis use. We reviewed the medical records of patients (N = 8157) with schizophrenia or schizoaffective disorder discharged from the hospital between 2008 and 2012. The patients were divided into two groups; those with urine drug tests positive for cannabis and those negative for cannabis. Doses of antipsychotic medications were converted to chlorpromazine equivalents. Bivariate analyses were done with Student's t test for continuous variables and χ 2 test for categorical variables. Linear regression was carried out to adjust for potential confounders. Unadjusted analysis revealed that the cannabis positive group was discharged on lower doses of antipsychotic medication compared with the cannabis negative group (geometric mean chlorpromazine equivalent doses 431.22 ± 2.20 vs 485.18 ± 2.21; P schizoaffective disorder.

  6. Teaching medical students about communication in speech-language disorders: Effects of a lecture and a workshop.

    Science.gov (United States)

    Saldert, Charlotta; Forsgren, Emma; Hartelius, Lena

    2016-12-01

    This study aims to explore the effects of an interactive workshop involving speech-language pathology students on medical students' knowledge about communication in relation to speech-language disorders. Fifty-nine medical students received a lecture about speech-language disorders. Twenty-six of them also participated in a workshop on communication with patients with speech-language disorders. All students completed a 12-item questionnaire exploring knowledge and attitudes towards communication before and after the lecture or the workshop. The results from the two groups' self-ratings of confidence in knowledge were compared with expert-ratings of their ability to choose suitable communicative strategies. Both the lecture and the workshop increased the students' confidence in knowledge about speech-language disorders and how to support communication. Only the workshop group also displayed a statistically significant increase in expert-rated ability and changed their attitude regarding responsibility for the communication in cases of speech-language disorders. There were no statistically significant correlations between the student's own confidence ratings and the experts' ratings of ability. Increased confidence in knowledge from learning is not always reflected in actual knowledge in how to communicate. However, an interactive workshop proved to increase medical students' expert-rated ability and attitudes related to communication in cases of speech-language disorders.

  7. Disorder-specific predictive classification of adolescents with attention deficit hyperactivity disorder (ADHD relative to autism using structural magnetic resonance imaging.

    Directory of Open Access Journals (Sweden)

    Lena Lim

    Full Text Available Attention Deficit Hyperactivity Disorder (ADHD is a neurodevelopmental disorder, but diagnosed by subjective clinical and rating measures. The study's aim was to apply Gaussian process classification (GPC to grey matter (GM volumetric data, to assess whether individual ADHD adolescents can be accurately differentiated from healthy controls based on objective, brain structure measures and whether this is disorder-specific relative to autism spectrum disorder (ASD.Twenty-nine adolescent ADHD boys and 29 age-matched healthy and 19 boys with ASD were scanned. GPC was applied to make disorder-specific predictions of ADHD diagnostic status based on individual brain structure patterns. In addition, voxel-based morphometry (VBM analysis tested for traditional univariate group level differences in GM.The pattern of GM correctly classified 75.9% of patients and 82.8% of controls, achieving an overall classification accuracy of 79.3%. Furthermore, classification was disorder-specific relative to ASD. The discriminating GM patterns showed higher classification weights for ADHD in earlier developing ventrolateral/premotor fronto-temporo-limbic and stronger classification weights for healthy controls in later developing dorsolateral fronto-striato-parieto-cerebellar networks. Several regions were also decreased in GM in ADHD relative to healthy controls in the univariate VBM analysis, suggesting they are GM deficit areas.The study provides evidence that pattern recognition analysis can provide significant individual diagnostic classification of ADHD patients and healthy controls based on distributed GM patterns with 79.3% accuracy and that this is disorder-specific relative to ASD. Findings are a promising first step towards finding an objective differential diagnostic tool based on brain imaging measures to aid with the subjective clinical diagnosis of ADHD.

  8. Examining Differences between Students with Specific Learning Disabilities and Those with Specific Language Disorders on Cognition, Emotions and Psychopathology

    Science.gov (United States)

    Filippatou, Diamanto; Dimitropoulou, Panagiota; Sideridis, Georgios

    2009-01-01

    The purpose of the present study was to investigate the differences between students with LD and SLI on emotional psychopathology and cognitive variables. In particular, the study examined whether cognitive, emotional, and psychopathology variables are significant discriminatory variables of speech and language disordered groups versus those…

  9. Repint of "Reframing autism as a behavioral syndrome and not a specific mental disorder: Implications of genetic and phenotypic heterogeneity".

    Science.gov (United States)

    Tordjman, S; Cohen, D; Anderson, G M; Botbol, M; Canitano, R; Coulon, N; Roubertoux, P L

    2018-06-01

    Clinical and molecular genetics have advanced current knowledge on genetic disorders associated with autism. A review of diverse genetic disorders associated with autism is presented and for the first time discussed extensively with regard to possible common underlying mechanisms leading to a similar cognitive-behavioral phenotype of autism. The possible role of interactions between genetic and environmental factors, including epigenetic mechanisms, is in particular examined. Finally, the pertinence of distinguishing non-syndromic autism (isolated autism) from syndromic autism (autism associated with genetic disorders) will be reconsidered. Given the high genetic and etiological heterogeneity of autism, autism can be viewed as a behavioral syndrome related to known genetic disorders (syndromic autism) or currently unknown disorders (apparent non-syndromic autism), rather than a specific categorical mental disorder. It highlights the need to study autism phenotype and developmental trajectory through a multidimensional, non-categorical approach with multivariate analyses within autism spectrum disorder but also across mental disorders, and to conduct systematically clinical genetic examination searching for genetic disorders in all individuals (children but also adults) with autism. Copyright © 2018. Published by Elsevier Ltd.

  10. Reframing autism as a behavioral syndrome and not a specific mental disorder: Implications of genetic and phenotypic heterogeneity.

    Science.gov (United States)

    Tordjman, S; Cohen, D; Coulon, N; Anderson, G M; Botbol, M; Canitano, R; Roubertoux, P L

    2017-01-30

    Clinical and molecular genetics have advanced current knowledge on genetic disorders associated with autism. A review of diverse genetic disorders associated with autism is presented and for the first time discussed extensively with regard to possible common underlying mechanisms leading to a similar cognitive-behavioral phenotype of autism. The possible role of interactions between genetic and environmental factors, including epigenetic mechanisms, is in particular examined. Finally, the pertinence of distinguishing non-syndromic autism (isolated autism) from syndromic autism (autism associated with genetic disorders) will be reconsidered. Given the high genetic and etiological heterogeneity of autism, autism can be viewed as a behavioral syndrome related to known genetic disorders (syndromic autism) or currently unknown disorders (apparent non-syndromic autism), rather than a specific categorical mental disorder. It highlights the need to study autism phenotype and developmental trajectory through a multidimensional, non-categorical approach with multivariate analyses within autism spectrum disorder but also across mental disorders, and to conduct systematically clinical genetic examination searching for genetic disorders in all individuals (children but also adults) with autism. Copyright © 2017. Published by Elsevier Ltd.

  11. Just-in-time Design and Additive Manufacture of Patient-specific Medical Implants

    Science.gov (United States)

    Shidid, Darpan; Leary, Martin; Choong, Peter; Brandt, Milan

    Recent advances in medical imaging and manufacturing science have enabled the design and production of complex, patient-specific orthopaedic implants. Additive Manufacture (AM) generates three-dimensional structures layer by layer, and is not subject to the constraints associated with traditional manufacturing methods. AM provides significant opportunities for the design of novel geometries and complex lattice structures with enhanced functional performance. However, the design and manufacture of patient-specific AM implant structures requires unique expertise in handling various optimization platforms. Furthermore, the design process for complex structures is computationally intensive. The primary aim of this research is to enable the just-in-time customisation of AM prosthesis; whereby AM implant design and manufacture be completed within the time constraints of a single surgical procedure, while minimising prosthesis mass and optimising the lattice structure to match the stiffness of the surrounding bone tissue. In this research, a design approach using raw CT scan data is applied to the AM manufacture of femoral prosthesis. Using the proposed just-in-time concept, the mass of the prosthesis was rapidly designed and manufactured while satisfying the associated structural requirements. Compressive testing of lattice structures manufactured using proposed method shows that the load carrying capacity of the resected composite bone can be recovered by up to 85% and the compressive stiffness of the AM prosthesis is statistically indistinguishable from the stiffness of the initial bone.

  12. Overlapping and disease specific trait, response, and reflection impulsivity in adolescents with first-episode schizophrenia spectrum disorders or attention-deficit/hyperactivity disorder

    DEFF Research Database (Denmark)

    Jepsen, J. R.M.; Rydkjaer, J.; Fagerlund, B.

    2018-01-01

    and Schizophrenia for School-aged Children – Present and Lifetime Version. Subjects with early-onset, first-episode schizophrenia spectrum disorders (EOS) (N = 29) or ADHD (N = 29) and healthy controls (N = 45) were compared on two performance measures (Information Sampling Task, Stop Signal Task) and a subjective......Background: Schizophrenia and attention-deficit/hyperactivity disorder (ADHD) are developmental disorders with shared clinical characteristics such as cognitive impairments and impulsivity. Impulsivity is a core feature of ADHD and an important factor in aggression, violence, and substance use...... in schizophrenia. Based on the hypothesis that schizophrenia and ADHD represent a continuum of neurodevelopmental impairments, the aim was to identify overlapping and disease specific forms of impulsivity. Methods: Adolescents between 12 and 17 years of age were assessed with the Schedule for Affective Disorders...

  13. Overlapping and disease specific aspects of impulsivety in children and adolescents with schiozphrenia spectrum disorders or Attention-Deficit/Hyperactivity Disorder

    DEFF Research Database (Denmark)

    Jepsen, Jens Richardt Møllegaard; Rydkjær, Jacob; Fagerlund, Birgitte

    making to gather more information in a condition with a conflict between reward and certainty. The reduced information sampling may also reflect an increased risk-taking or conviction in the decision at a point of relative uncertainty. Children and adolescents with schizophrenia spectrum disorder......Background and aim: Dimensions of impulsivity have been observed in Attention-Deficit/Hyperactivity Disorder (ADHD) and schizophrenia patients. The purpose is to identify disease specific and overlapping aspects of impulsivity in children and adolescents with ADHD or early-onset schizophrenia......-onset schizophrenia spectrum disorder patients appear to perform differently from the healthy controls and the schizphrenia spectrum disorder patients, although not signivicantly (p = .163). Conclusion: Reduced information sampling in children and adolescents with ADHD may reflect an inability to delay their decision...

  14. Specificity of posttraumatic stress disorder symptoms: an investigation of comorbidity between posttraumatic stress disorder symptoms and depression in treatment-seeking veterans.

    Science.gov (United States)

    Gros, Daniel F; Simms, Leonard J; Acierno, Ron

    2010-12-01

    In response to high levels of comorbidity and symptom overlap between posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and other disorders, much attention has been devoted to the role of specific and nonspecific symptoms among the disorders. The present study investigated the overlapping symptoms of PTSD and MDD in treatment-seeking veterans. Exploratory factor analyses were used to identify latent factors of both self-reported and clinician-rated symptoms of PTSD and MDD. Results of exploratory factor analyses supported a 2-factor model representing symptoms of depression and PTSD; however, a subset of PTSD symptoms, characterized by emotional numbing and dysphoria, loaded onto the depression factor, rather than the PTSD factor. These nonspecific PTSD symptoms were predictive of comorbid MDD and increased depression symptomatology in patients with PTSD. Together, these findings demonstrate the importance of accounting for nonspecific symptoms in diagnosis and treatment of PTSD, highlighting a need for revisions to our current diagnostics.

  15. Occlusion and temporomandibular disorders: a malpractice case with medical legal considerations.

    Science.gov (United States)

    Bucci, M B; Aversa, M; Guarda-Nardini, L; Manfredini, D

    2011-01-01

    Occlusion and temporomandibular The issue of temporomandibular disorders (TMD) diagnosis and treatment has become a matter of increasing interest in the medical legal field in recent years. The old-fashioned theories based on the occlusal paradigm was proven to be erroneous, and clinicians who still provide irreversible treatments to TMD patients have to be conscious of the potential legal consequences of their behavior. The present paper described an illustrative case report of a patient to whom extensive and irreversible occlusal therapies were performed with the unique aim to provide relief from TMD symptoms. The treatment was unsuccessful and the dental practitioner was called into cause for a professional liability claim. The clinician was judged guilty of malpractice on the basis of the lack of scientific evidence of the irreversible occlusal approaches to TMD, which were erroneously used and did not give the patient any benefit, thus forcing him to a non necessary financial and biological cost. The failure to satisfy the contract with the patient, which is usually not covered by any insurance company, forced the practitioner to give the money back to the patient. The ethical and legal implications of such case were discussed, with particular focus on the concept that medical legal advices need to satisfy the highest standards of evidence and have to be strictly based on scientific knowledge.

  16. Subclinical symptoms of attention-deficit/hyperactivity disorder (ADHD) are associated with specific creative processes

    NARCIS (Netherlands)

    Boot, N.; Nevicka, B.; Baas, M.

    Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by distractibility, hyperactivity, and impulsive behavior. Although ADHD generally associates with a range of cognitive impairments, evidence suggests that people with ADHD may be more creative than people

  17. Medical Image Processing for Fully Integrated Subject Specific Whole Brain Mesh Generation

    Directory of Open Access Journals (Sweden)

    Chih-Yang Hsu

    2015-05-01

    Full Text Available Currently, anatomically consistent segmentation of vascular trees acquired with magnetic resonance imaging requires the use of multiple image processing steps, which, in turn, depend on manual intervention. In effect, segmentation of vascular trees from medical images is time consuming and error prone due to the tortuous geometry and weak signal in small blood vessels. To overcome errors and accelerate the image processing time, we introduce an automatic image processing pipeline for constructing subject specific computational meshes for entire cerebral vasculature, including segmentation of ancillary structures; the grey and white matter, cerebrospinal fluid space, skull, and scalp. To demonstrate the validity of the new pipeline, we segmented the entire intracranial compartment with special attention of the angioarchitecture from magnetic resonance imaging acquired for two healthy volunteers. The raw images were processed through our pipeline for automatic segmentation and mesh generation. Due to partial volume effect and finite resolution, the computational meshes intersect with each other at respective interfaces. To eliminate anatomically inconsistent overlap, we utilized morphological operations to separate the structures with a physiologically sound gap spaces. The resulting meshes exhibit anatomically correct spatial extent and relative positions without intersections. For validation, we computed critical biometrics of the angioarchitecture, the cortical surfaces, ventricular system, and cerebrospinal fluid (CSF spaces and compared against literature values. Volumina and surface areas of the computational mesh were found to be in physiological ranges. In conclusion, we present an automatic image processing pipeline to automate the segmentation of the main intracranial compartments including a subject-specific vascular trees. These computational meshes can be used in 3D immersive visualization for diagnosis, surgery planning with haptics

  18. Are the components of social reciprocity transdiagnostic across pediatric neurodevelopmental disorders? Evidence for common and disorder-specific social impairments.

    Science.gov (United States)

    Sturm, Alexandra; Rozenman, Michelle; Chang, Susanna; McGough, James J; McCracken, James T; Piacentini, John C

    2018-06-01

    Deficits in social communication are a core feature of autism spectrum disorder (ASD), yet significant social problems have been observed in youth with many neurodevelopmental disorders. In this preliminary investigation, we aimed to explore whether domains of social reciprocity (i.e., social communication, social cognition, social awareness, social motivation, and restricted and repetitive behaviors) represent transdiagnostic traits. These domains were compared across youth ages 7-17 with obsessive-compulsive disorder (OCD; N = 32), tic disorders (TD; N = 20), severe mood dysregulation (N = 33) and autism spectrum disorder (N = 35). While the ASD group was rated by parents as exhibiting the greatest social reciprocity deficits across domains, a high proportion of youth with severe mood dysregulation also exhibited pronounced deficits in social communication, cognition, and awareness. The ASD and severe mood dysregulation groups demonstrated comparable scores on the social awareness domain. In contrast, social motivation and restricted and repetitive behaviors did not appear to be transdiagnostic domains in severe mood dysregulation, OCD, or TD groups. The present work provides preliminary support that social awareness, and to a lesser extent social communication and cognition, may represent features of social reciprocity that are transdiagnostic across ASD and severe mood dysregulation. Copyright © 2018 Elsevier B.V. All rights reserved.

  19. Abnormalities of white matter microstructure in unmedicated obsessive-compulsive disorder and changes after medication.

    Directory of Open Access Journals (Sweden)

    Qing Fan

    Full Text Available BACKGROUND: Abnormalities of myelin integrity have been reported in obsessive-compulsive disorder (OCD using multi-parameter maps of diffusion tensor imaging (DTI. However, it was still unknown to what degree these abnormalities might be affected by pharmacological treatment. OBJECTIVE: To investigate whether the abnormalities of white matter microstructure including myelin integrity exist in OCD and whether they are affected by medication. METHODOLOGY AND PRINCIPAL FINDINGS: Parameter maps of DTI, including fractional anisotropy (FA, axial diffusivity (AD, radial diffusivity (RD and mean diffusivity (MD, were acquired from 27 unmedicated OCD patients (including 13 drug-naïve individuals and 23 healthy controls. Voxel-based analysis was then performed to detect regions with significant group difference. We compared the DTI-derived parameters of 15 patients before and after 12-week Selective Serotonin Reuptake Inhibitor (SSRI therapies. Significant differences of DTI-derived parameters were observed between OCD and healthy groups in multiple structures, mainly within the fronto-striato-thalamo-cortical loop. An increased RD in combination with no change in AD among OCD patients was found in the left medial superior frontal gyrus, temporo-parietal lobe, occipital lobe, striatum, insula and right midbrain. There was no statistical difference in DTI-derived parameters between drug-naive and previously medicated OCD patients. After being medicated, OCD patients showed a reduction in RD of the left striatum and right midbrain, and in MD of the right midbrain. CONCLUSION: Our preliminary findings suggest that abnormalities of white matter microstructure, particularly in terms of myelin integrity, are primarily located within the fronto-striato-thalamo-cortical circuit of individuals with OCD. Some abnormalities may be partly reversed by SSRI treatment.

  20. [Specific developmental language disorder: a theoretical approach to its diagnosis, aetiology and clinical symptoms].

    Science.gov (United States)

    Castro-Rebolledo, R; Giraldo-Prieto, M; Hincapié-Henao, L; Lopera, F; Pineda, D A

    This article presents an updated review about the definition, diagnostic criteria, classifications, etiology and the evolution of the specific language impairment (SLI). The specific language impairment is characterized by a developmental language delay and an impaired language, that persist over time and it is not explained by sensorial, motor and mental disabilities, neither by psycopathological disorders, socio-emotional deprivation, nor brain injury. The diagnosis is based on exclusional criteria. Some researchers propose different classifications considering the children performance in language comprehension and language production. Genetical linkage to the FOXP2 gen in the SPCH1 region of the chromosome 7 and to the chromosomes 13, 16 y 19 has been reported. The neuroimage studies have shown alterations in the volume and perfusion of some brain structures related to language. The manifestations of SLI may change during the development of the children and may disturb the self-esteem, the academic performance and the social abilities. The variability in the linguistic and cognitive performance, and the variety in the etiological findings in children with SLI, don't allow to settle the affected population as an homogeneous group. Different theoretical positions have emerged as a consequence of this condition.

  1. Outcomes of an inpatient medical nutritional rehabilitation protocol in children and adolescents with eating disorders.

    Science.gov (United States)

    Peebles, Rebecka; Lesser, Andrew; Park, Courtney Cheek; Heckert, Kerri; Timko, C Alix; Lantzouni, Eleni; Liebman, Ronald; Weaver, Laurel

    2017-01-01

    Medical stabilization through inpatient nutritional rehabilitation is often necessary for patients with eating disorders (EDs) but includes the inherent risk of refeeding syndrome. Here we describe our experience of implementing and sustaining an inpatient nutritional rehabilitation protocol designed to strategically prepare patients with EDs and their families for discharge to a home setting in an efficient and effective manner from a general adolescent medicine unit. We report outcomes at admission, discharge, and 4-weeks follow-up. Protocol development, implementation, and unique features of the protocol, are described. Data were collected retrospectively as part of a continuous quality improvement (QI) initiative. Safety outcomes were the clinical need for phosphorus, potassium, and magnesium supplementation, other evidence of refeeding syndrome, and unexpected readmissions within one month of discharge. The value outcome was length of stay (LOS). Treatment outcomes were the percentage median BMI (MBMI) change from admission to discharge, and from discharge to 4-weeks follow-up visit. A total of 215 patients (88% F, 12% M) were included. Patients averaged 15.3 years old (5.8-23.2y); 64% had AN, 18% had atypical anorexia (AtAN), 6% bulimia nervosa (BN), 5% purging disorder (PD), 4% avoidant-restrictive food intake disorder (ARFID), and 3% had an unspecified food and eating disorder (UFED). Average LOS was 11 days. Initial mean calorie level for patients at admission was 1466 and at discharge 3800 kcals/day. Phosphorus supplementation for refeeding hypophosphatemia (RH) was needed in 14% of inpatients; full-threshold refeeding syndrome did not occur. Only 3.8% were rehospitalized in the thirty days after discharge. Patients averaged 86.1% of a median MBMI for age and gender, 91.4% MBMI at discharge, and 100.9% MBMI at 4-weeks follow-up. Mean percentage MBMI differences between time points were significantly different (admission-discharge: 5.3%, p  <0

  2. Current approaches to treatments for schizophrenia spectrum disorders, part I: an overview and medical treatments

    Directory of Open Access Journals (Sweden)

    Chien WT

    2013-09-01

    Full Text Available Wai Tong Chien, Annie LK Yip School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong Abstract: During the last three decades, an increasing understanding of the etiology, psychopathology, and clinical manifestations of schizophrenia spectrum disorders, in addition to the introduction of second-generation antipsychotics, has optimized the potential for recovery from the illness. Continued development of various models of psychosocial intervention promotes the goal of schizophrenia treatment from one of symptom control and social adaptation to an optimal restoration of functioning and/or recovery. However, it is still questionable whether these new treatment approaches can address the patients' needs for treatment and services and contribute to better patient outcomes. This article provides an overview of different treatment approaches currently used in schizophrenia spectrum disorders to address complex health problems and a wide range of abnormalities and impairments resulting from the illness. There are different treatment strategies and targets for patients at different stages of the illness, ranging from prophylactic antipsychotics and cognitive–behavioral therapy in the premorbid stage to various psychosocial interventions in addition to antipsychotics for relapse prevention and rehabilitation in the later stages of the illness. The use of antipsychotics alone as the main treatment modality may be limited not only in being unable to tackle the frequently occurring negative symptoms and cognitive impairments but also in producing a wide variety of adverse effects to the body or organ functioning. Because of varied pharmacokinetics and treatment responsiveness across agents, the medication regimen should be determined on an individual basis to ensure an optimal effect in its long-term use. This review also highlights that the recent practice guidelines and standards have

  3. Genetic Risk for Conduct Disorder Symptom Subtypes in an ADHD Sample: Specificity to Aggressive Symptoms

    Science.gov (United States)

    Monuteaux, Michael C.; Biederman, Joseph; Doyle, Alysa E.; Mick, Eric; Faraone, Stephen V.

    2009-01-01

    Four hundred forty-four subjects aged 6-55 years were evaluated to examine the role of COMT and SLC6A4 genes in the risk for conduct disorder and its symptomatic subtypes in the context of attention deficit hyperactivity disorder. No significant association is found between these genes and the risk for conduct disorder.

  4. Associations between Medication Use and Functional Gastrointestinal Disorders: A Population-Based Study

    Science.gov (United States)

    Choung, Rok Seon; Locke, G. Richard.; Schleck, Cathy D.; Zinsmeister, Alan R.; Talley, Nicholas J.

    2013-01-01

    Background Functional GI syndromes are known to be very prevalent but this may be associated with unrecognized medications use. We aimed to estimate the prevalence of PPI, antidepressant, and narcotic use in the general population, and evaluate the association between each medication and functional GI syndromes adjusting for potential confounders. Methods In 2008 and 2009, newly revised versions of a validated bowel disease questionnaire were mailed to a community based cohort (total mailed=8006) of Olmsted County, MN residents; 3831 returned the questionnaire (response rate=48.0%). Medication usage, specifically PPIs, narcotics, and antidepressants in the last year, was elicited via three separate questions on the questionnaire. The association between each medication and GI symptom complexes was assessed using multiple variable logistic regression models. Results A total of 3515 of the respondents (92%) had complete data (mean age: 61±15; 54% female). The overall proportion reporting PPI use was 20% (95% CI: 19, 22), narcotic use 12% (95% CI: 11, 13), and antidepressant use 15% (95% CI: 14, 16). PPI use was significantly associated with IBS status (OR=1.4, 95% CI 1.1, 1.7) as well as with GERD (OR=3.5, 95% CI 2.7, 4.4) and dyspepsia (OR=2.0, 95% CI 1.5, 2.7). The association of PPI use with IBS was not explained by coexistent GERD or dyspepsia. Antidepressant use was significantly associated only with bloating (OR=1.6, 1.1, 2.2). Conclusions Some medications that may alter intestinal transit or bowel flora are commonly utilized by the general population, and PPI use appears to be linked to IBS. PMID:23360217

  5. Specific features of suicidal behavior in patients with narcissistic personality disorder.

    Science.gov (United States)

    Blasco-Fontecilla, Hilario; Baca-Garcia, Enrique; Dervic, Kanita; Perez-Rodriguez, M Mercedes; Lopez-Castroman, Jorge; Saiz-Ruiz, Jeronimo; Oquendo, Maria A

    2009-11-01

    Suicidal behavior is a clinically significant but underestimated cause of mortality in narcissistic personality disorder. Currently, there are no reliable estimates of suicidal behavior for this population. The main objective of this study was to test whether or not suicide attempters diagnosed with narcissistic personality disorder are different in terms of impulsivity and expected lethality from suicide attempters with other cluster B personality disorders. In a sample of 446 suicide attempters, patients with cluster B personality disorder diagnoses (n = 254) as assessed by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), version of the International Personality Disorder Examination-Screening Questionnaire (IPDE-SQ) were compared in terms of expected lethality and impulsivity (measured by the Beck Suicidal Intent Scale and the Barratt Impulsiveness Scale, respectively). The subjects were admitted to the emergency departments of the Ramón y Cajal Hospital and the Fundación Jiménez Diaz University Hospital in Madrid, Spain, between January 1999 and January 2003. Suicide attempts of subjects diagnosed with narcissistic personality disorder had higher expected lethality than those of subjects without narcissistic personality disorder (t = -4.24, df = 439, P personality disorder (t = 0.28, df = 439, P = .795), antisocial personality disorder (t = 0.66, df = 439, P = .504), and borderline personality disorder (t = 1.13, df = 439, P = .256), respectively. Suicide attempters diagnosed with narcissistic personality disorder did not significantly differ from suicide attempters without narcissistic personality disorder in terms of impulsivity measures (t = -0.33, df = 442, P = .738), while suicide attempters diagnosed with antisocial personality disorder, histrionic personality disorder, and borderline personality disorder were significantly more impulsive than suicide attempters without these diagnoses (t = -3.96, df = 442, P

  6. 21 CFR 1000.50 - Recommendation for the use of specific area gonad shielding on patients during medical diagnostic...

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Recommendation for the use of specific area gonad shielding on patients during medical diagnostic x-ray procedures. 1000.50 Section 1000.50 Food and Drugs... GENERAL Radiation Protection Recommendations § 1000.50 Recommendation for the use of specific area gonad...

  7. Comparison of a Broad-Based Screen versus Disorder-Specific Screen in Detecting Young Children with an Autism Spectrum Disorder

    Science.gov (United States)

    Wiggins, Lisa D; Piazza, Vivian; Robins, Diana L

    2014-01-01

    The goals of our study were to (a) compare agreement between autism spectrum disorder diagnosis and outcome of the Modified Checklist for Autism in Toddlers and Parents Evaluation of Developmental Status in a sample of toddlers and (b) examine specific concerns noted for toddlers who screened negative on the Modified Checklist for Autism in…

  8. Autistic symptomatology and language ability in autism spectrum disorder and specific language impairment.

    Science.gov (United States)

    Loucas, Tom; Charman, Tony; Pickles, Andrew; Simonoff, Emily; Chandler, Susie; Meldrum, David; Baird, Gillian

    2008-11-01

    Autism spectrum disorders (ASD) and specific language impairment (SLI) are common developmental disorders characterised by deficits in language and communication. The nature of the relationship between them continues to be a matter of debate. This study investigates whether the co-occurrence of ASD and language impairment is associated with differences in severity or pattern of autistic symptomatology or language profile. Participants (N = 97) were drawn from a total population cohort of 56,946 screened as part of study to ascertain the prevalence of ASD, aged 9 to 14 years. All children received an ICD-10 clinical diagnosis of ASD or No ASD. Children with nonverbal IQ > or =80 were divided into those with a language impairment (language score of 77 or less) and those without, creating three groups: children with ASD and a language impairment (ALI; N = 41), those with ASD and but no language impairment (ANL; N = 31) and those with language impairment but no ASD (SLI; N = 25). Children with ALI did not show more current autistic symptoms than those with ANL. Children with SLI were well below the threshold for ASD. Their social adaptation was higher than the ASD groups, but still nearly 2 SD below average. In ALI the combination of ASD and language impairment was associated with weaker functional communication and more severe receptive language difficulties than those found in SLI. Receptive and expressive language were equally impaired in ALI, whereas in SLI receptive language was stronger than expressive. Co-occurrence of ASD and language impairment is not associated with increased current autistic symptomatology but appears to be associated with greater impairment in receptive language and functional communication.

  9. Specific alterations in plasma proteins during depressed, manic, and euthymic states of bipolar disorder

    Energy Technology Data Exchange (ETDEWEB)

    Song, Y.R. [Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing (China); Chongqing Key Laboratory of Neurobiology, Chongqing (China); Institute of Neuroscience and the Collaborative Innovation Center for Brain Science, Chongqing Medical University, Chongqing (China); Wu, B. [Chongqing Key Laboratory of Neurobiology, Chongqing (China); Institute of Neuroscience and the Collaborative Innovation Center for Brain Science, Chongqing Medical University, Chongqing (China); Yang, Y.T.; Chen, J. [Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing (China); Chongqing Key Laboratory of Neurobiology, Chongqing (China); Institute of Neuroscience and the Collaborative Innovation Center for Brain Science, Chongqing Medical University, Chongqing (China); Zhang, L.J.; Zhang, Z.W. [Chongqing Key Laboratory of Neurobiology, Chongqing (China); Institute of Neuroscience and the Collaborative Innovation Center for Brain Science, Chongqing Medical University, Chongqing (China); Shi, H.Y. [Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing (China); Chongqing Key Laboratory of Neurobiology, Chongqing (China); Institute of Neuroscience and the Collaborative Innovation Center for Brain Science, Chongqing Medical University, Chongqing (China); Huang, C.L.; Pan, J.X. [Chongqing Key Laboratory of Neurobiology, Chongqing (China); Institute of Neuroscience and the Collaborative Innovation Center for Brain Science, Chongqing Medical University, Chongqing (China); Xie, P. [Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing (China); Chongqing Key Laboratory of Neurobiology, Chongqing (China); Institute of Neuroscience and the Collaborative Innovation Center for Brain Science, Chongqing Medical University, Chongqing (China)

    2015-09-08

    Bipolar disorder (BD) is a common psychiatric mood disorder affecting more than 1-2% of the general population of different European countries. Unfortunately, there is no objective laboratory-based test to aid BD diagnosis or monitor its progression, and little is known about the molecular basis of BD. Here, we performed a comparative proteomic study to identify differentially expressed plasma proteins in various BD mood states (depressed BD, manic BD, and euthymic BD) relative to healthy controls. A total of 10 euthymic BD, 20 depressed BD, 15 manic BD, and 20 demographically matched healthy control subjects were recruited. Seven high-abundance proteins were immunodepleted in plasma samples from the 4 experimental groups, which were then subjected to proteome-wide expression profiling by two-dimensional electrophoresis and matrix-assisted laser desorption/ionization-time-of-flight/time-of-flight tandem mass spectrometry. Proteomic results were validated by immunoblotting and bioinformatically analyzed using MetaCore. From a total of 32 proteins identified with 1.5-fold changes in expression compared with healthy controls, 16 proteins were perturbed in BD independent of mood state, while 16 proteins were specifically associated with particular BD mood states. Two mood-independent differential proteins, apolipoprotein (Apo) A1 and Apo L1, suggest that BD pathophysiology may be associated with early perturbations in lipid metabolism. Moreover, down-regulation of one mood-dependent protein, carbonic anhydrase 1 (CA-1), suggests it may be involved in the pathophysiology of depressive episodes in BD. Thus, BD pathophysiology may be associated with early perturbations in lipid metabolism that are independent of mood state, while CA-1 may be involved in the pathophysiology of depressive episodes.

  10. Specific alterations in plasma proteins during depressed, manic, and euthymic states of bipolar disorder

    International Nuclear Information System (INIS)

    Song, Y.R.; Wu, B.; Yang, Y.T.; Chen, J.; Zhang, L.J.; Zhang, Z.W.; Shi, H.Y.; Huang, C.L.; Pan, J.X.; Xie, P.

    2015-01-01

    Bipolar disorder (BD) is a common psychiatric mood disorder affecting more than 1-2% of the general population of different European countries. Unfortunately, there is no objective laboratory-based test to aid BD diagnosis or monitor its progression, and little is known about the molecular basis of BD. Here, we performed a comparative proteomic study to identify differentially expressed plasma proteins in various BD mood states (depressed BD, manic BD, and euthymic BD) relative to healthy controls. A total of 10 euthymic BD, 20 depressed BD, 15 manic BD, and 20 demographically matched healthy control subjects were recruited. Seven high-abundance proteins were immunodepleted in plasma samples from the 4 experimental groups, which were then subjected to proteome-wide expression profiling by two-dimensional electrophoresis and matrix-assisted laser desorption/ionization-time-of-flight/time-of-flight tandem mass spectrometry. Proteomic results were validated by immunoblotting and bioinformatically analyzed using MetaCore. From a total of 32 proteins identified with 1.5-fold changes in expression compared with healthy controls, 16 proteins were perturbed in BD independent of mood state, while 16 proteins were specifically associated with particular BD mood states. Two mood-independent differential proteins, apolipoprotein (Apo) A1 and Apo L1, suggest that BD pathophysiology may be associated with early perturbations in lipid metabolism. Moreover, down-regulation of one mood-dependent protein, carbonic anhydrase 1 (CA-1), suggests it may be involved in the pathophysiology of depressive episodes in BD. Thus, BD pathophysiology may be associated with early perturbations in lipid metabolism that are independent of mood state, while CA-1 may be involved in the pathophysiology of depressive episodes

  11. Parameterization of disorder predictors for large-scale applications requiring high specificity by using an extended benchmark dataset

    Directory of Open Access Journals (Sweden)

    Eisenhaber Frank

    2010-02-01

    Full Text Available Abstract Background Algorithms designed to predict protein disorder play an important role in structural and functional genomics, as disordered regions have been reported to participate in important cellular processes. Consequently, several methods with different underlying principles for disorder prediction have been independently developed by various groups. For assessing their usability in automated workflows, we are interested in identifying parameter settings and threshold selections, under which the performance of these predictors becomes directly comparable. Results First, we derived a new benchmark set that accounts for different flavours of disorder complemented with a similar amount of order annotation derived for the same protein set. We show that, using the recommended default parameters, the programs tested are producing a wide range of predictions at different levels of specificity and sensitivity. We identify settings, in which the different predictors have the same false positive rate. We assess conditions when sets of predictors can be run together to derive consensus or complementary predictions. This is useful in the framework of proteome-wide applications where high specificity is required such as in our in-house sequence analysis pipeline and the ANNIE webserver. Conclusions This work identifies parameter settings and thresholds for a selection of disorder predictors to produce comparable results at a desired level of specificity over a newly derived benchmark dataset that accounts equally for ordered and disordered regions of different lengths.

  12. Eating disorder-specific risk factors moderate the relationship between negative urgency and binge eating: A behavioral genetic investigation.

    Science.gov (United States)

    Racine, Sarah E; VanHuysse, Jessica L; Keel, Pamela K; Burt, S Alexandra; Neale, Michael C; Boker, Steven; Klump, Kelly L

    2017-07-01

    Theoretical models of binge eating and eating disorders include both transdiagnostic and eating disorder-specific risk factors. Negative urgency (i.e., the tendency to act impulsively when distressed) is a critical transdiagnostic risk factor for binge eating, but limited research has examined interactions between negative urgency and disorder-specific variables. Investigating these interactions can help identify the circumstances under which negative urgency is most strongly associated with binge eating. We examined whether prominent risk factors (i.e., appearance pressures, thin-ideal internalization, body dissatisfaction, dietary restraint) specified in well-established etiologic models of eating disorders moderate negative urgency-binge eating associations. Further, we investigated whether phenotypic moderation effects were due to genetic and/or environmental associations between negative urgency and binge eating. Participants were 988 female twins aged 11-25 years from the Michigan State University Twin Registry. Appearance pressures, thin-ideal internalization, and body dissatisfaction, but not dietary restraint, significantly moderated negative urgency-binge eating associations, with high levels of these risk factors and high negative urgency associated with the greatest binge eating. Twin moderation models revealed that genetic, but not environmental, sharing between negative urgency and binge eating was enhanced at higher levels of these eating disorder-specific variables. Future longitudinal research should investigate whether eating disorder risk factors shape genetic influences on negative urgency into manifesting as binge eating. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  13. A Potential Tension in DSM-5: The General Definition of Mental Disorder versus Some Specific Diagnostic Criteria.

    Science.gov (United States)

    Amoretti, M Cristina; Lalumera, Elisabetta

    2018-05-30

    The general concept of mental disorder specified in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders is definitional in character: a mental disorder might be identified with a harmful dysfunction. The manual also contains the explicit claim that each individual mental disorder should meet the requirements posed by the definition. The aim of this article is two-fold. First, we shall analyze the definition of the superordinate concept of mental disorder to better understand what necessary (and sufficient) criteria actually characterize such a concept. Second, we shall consider the concepts of some individual mental disorders and show that they are in tension with the definition of the superordinate concept, taking pyromania and narcissistic personality disorder as case studies. Our main point is that an unexplained and not-operationalized dysfunction requirement that is included in the general definition, while being systematically violated by the diagnostic criteria of specific mental disorders, is a logical error. Then, either we unpack and operationalize the dysfunction requirement, and include explicit diagnostic criteria that can actually meet it, or we simply drop it.

  14. Impact of Psychoeducation on Knowledge of and Attitude Toward Medications in Clients With Schizophrenia and Schizoaffective Disorders.

    Science.gov (United States)

    Choe, Kwisoon; Sung, Byung-Ju; Kang, Youngmi; Yoo, So Yeon

    2016-04-01

    To examine a psychoeducational intervention's effects on knowledge and attitudes toward antipsychotic medication in clients with schizophrenia and schizoaffective disorders. A one-group pretest-posttest design was employed. A convenience sample (61 psychiatric clients aged 20 or above) was recruited from a Korean mental health center. At baseline, participants had limited knowledge (M = 50.89, range: 27-77, SD = 12.05) of and negative feelings toward antipsychotic medications (M = -.89, range: -8 to 8, SD = 4.27). Both measures significantly improved post-intervention. A psychoeducational intervention improved clients' knowledge of and attitudes toward antipsychotic medications. © 2015 Wiley Periodicals, Inc.

  15. An Overview of Multiple Sclerosis: Medical, Psychosocial, and Vocational Aspects of a Chronic and Unpredictable Neurological Disorder

    Science.gov (United States)

    Rumrill, Phillip D., Jr.; Roessler, Richard T.

    2015-01-01

    This article presents an overview of multiple sclerosis (MS), one of the most common neurological disorders in the western hemisphere. Medical and psychosocial aspects of the disease such as causes and risk factors, diagnosis, incidence and prevalence, symptoms, courses, and treatment are described. Existing research regarding the employment…

  16. Predictors and Moderators of Response to Cognitive Behavioral Therapy and Medication for the Treatment of Binge Eating Disorder

    Science.gov (United States)

    Grilo, Carlos M.; Masheb, Robin M.; Crosby, Ross D.

    2012-01-01

    Objective: To examine predictors and moderators of response to cognitive behavioral therapy (CBT) and medication treatments for binge-eating disorder (BED). Method: 108 BED patients in a randomized double-blind placebo-controlled trial testing CBT and fluoxetine treatments were assessed prior, throughout, and posttreatment. Demographic factors,…

  17. [Traditional Chinese medicine inheritance system analysis of professor Ding Yuanqing in treating tic disorder medication based on experience].

    Science.gov (United States)

    Sun, Lu-yan; Li, Qing-peng; Zhao, Li-li; Ding, Yuan-qing

    2015-08-01

    In recent years, the incidence of tic disorders has increased, and it is not uncommon for the patients to treat the disease. The pathogenesis and pathogenesis of Western medicine are not yet clear, the clinical commonly used western medicine has many adverse reactions, traditional Chinese medicine (TCM) research is increasingly valued. Based on the software of TCM inheritance assistant system, this paper discusses Ding Yuanqing's experience in treating tic disorder with Professor. Collect yuan Qing Ding professor in treating tic disorder of medical records by association rules Apriori algorithm, complex system entropy clustering without supervision and data mining method, carries on the analysis to the selected 800 prescriptions, to determine the frequency of use of prescription drugs, the association rules between the drug and digging out the 12 core combination and the first six new prescription, medication transferred to the liver and extinguish wind, cooling blood and relieving convulsion, Qingxin soothe the nerves, with the card cut, flexible application, strict compatibility.

  18. Clinical value of DSM IV and DSM 5 criteria for diagnosing the most prevalent somatoform disorders in patients with medically unexplained physical symptoms (MUPS).

    Science.gov (United States)

    van Dessel, Nikki Claassen-; van der Wouden, Johannes C; Dekker, Joost; van der Horst, Henriette E

    2016-03-01

    This study aimed (1) to describe frequencies of DSM IV somatisation disorder, undifferentiated somatoform disorder and pain disorder versus DSM 5 somatic symptom disorder (SSD) in a multi-setting population of patients with medically unexplained physical symptoms (MUPS), (2) to investigate differences in sociodemographic and (psycho)pathological characteristics between these diagnostic groups and (3) to explore the clinical relevance of the distinction between mild and moderate DSM 5 SSD. We used baseline data of a cohort of 325 MUPS patients. Measurements included questionnaires about symptom severity, physical functioning, anxiety, depression, health anxiety and illness perceptions. These questionnaires were used as proxy measures for operationalization of DSM IV and DSM 5 diagnostic criteria. 92.9% of participants fulfilled criteria of a DSM IV somatoform disorder, while 45.5% fulfilled criteria of DSM 5 SSD. Participants fulfilling criteria of DSM 5 SSD suffered from more severe symptoms than those only fulfilling criteria of a DSM IV somatoform disorder(mean PHQ-15 score of 13.98 (SD 5.17) versus 11.23 (SD 4.71), P-valuephysical functioning was significantly lower. Compared to patients with mild SSD, patients with moderate SSD suffered from significantly lower physical functioning and higher levels of depression. Within a population of MUPS patients DSM 5 SSD criteria are more restrictive than DSM IV criteria for somatoform disorders. They are associated with higher symptom severity and lower physical functioning. However, further specification of the positive psychological criteria of DSM 5 SSD may improve utility in research and practice. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Depot-medication compliance for patients with psychotic disorders: the importance of illness insight and treatment motivation.

    Science.gov (United States)

    Noordraven, Ernst L; Wierdsma, André I; Blanken, Peter; Bloemendaal, Anthony Ft; Mulder, Cornelis L

    2016-01-01

    Noncompliance is a major problem for patients with a psychotic disorder. Two important risk factors for noncompliance that have a severe negative impact on treatment outcomes are impaired illness insight and lack of motivation. Our cross-sectional study explored how they are related to each other and their compliance with depot medication. Interviews were conducted in 169 outpatients with a psychotic disorder taking depot medication. Four patient groups were defined based on low or high illness insight and on low or high motivation. The associations between depot-medication compliance, motivation, and insight were illustrated using generalized linear models. Generalized linear model showed a significant interaction effect between motivation and insight. Patients with poor insight and high motivation for treatment were more compliant (94%) (95% confidence interval [CI]: 1.821, 3.489) with their depot medication than patients with poor insight and low motivation (61%) (95% CI: 0.288, 0.615). Patients with both insight and high motivation for treatment were less compliant (73%) (95% CI: 0.719, 1.315) than those with poor insight and high motivation. Motivation for treatment was more strongly associated with depot-medication compliance than with illness insight. Being motivated to take medication, whether to get better or for other reasons, may be a more important factor than having illness insight in terms of improving depot-medication compliance. Possible implications for clinical practice are discussed.

  20. 78 FR 17917 - Medical Waivers for Merchant Mariner Credential Applicants With a History of Seizure Disorders

    Science.gov (United States)

    2013-03-25

    ... be considered for a waiver. (1) Mariners with a history of epilepsy or seizure disorder may be... Waivers for Merchant Mariner Credential Applicants With a History of Seizure Disorders AGENCY: Coast Guard... of seizure disorders. Coast Guard regulations provide that convulsive disorders (also known as...

  1. Recent advancements in medical simulation: patient-specific virtual reality simulation.

    Science.gov (United States)

    Willaert, Willem I M; Aggarwal, Rajesh; Van Herzeele, Isabelle; Cheshire, Nicholas J; Vermassen, Frank E

    2012-07-01

    Patient-specific virtual reality simulation (PSVR) is a new technological advancement that allows practice of upcoming real operations and complements the established role of VR simulation as a generic training tool. This review describes current developments in PSVR and draws parallels with other high-stake industries, such as aviation, military, and sports. A review of the literature was performed using PubMed and Internet search engines to retrieve data relevant to PSVR in medicine. All reports pertaining to PSVR were included. Reports on simulators that did not incorporate a haptic interface device were excluded from the review. Fifteen reports described 12 simulators that enabled PSVR. Medical procedures in the field of laparoscopy, vascular surgery, orthopedics, neurosurgery, and plastic surgery were included. In all cases, source data was two-dimensional CT or MRI data. Face validity was most commonly reported. Only one (vascular) simulator had undergone face, content, and construct validity. Of the 12 simulators, 1 is commercialized and 11 are prototypes. Five simulators have been used in conjunction with real patient procedures. PSVR is a promising technological advance within medicine. The majority of simulators are still in the prototype phase. As further developments unfold, the validity of PSVR will have to be examined much like generic VR simulation for training purposes. Nonetheless, similar to the aviation, military, and sport industries, operative performance and patient safety may be enhanced by the application of this novel technology.

  2. The use of medications approved for Alzheimer’s disease in autism spectrum disorder: a systematic review

    Directory of Open Access Journals (Sweden)

    Daniel eRossignol

    2014-08-01

    Full Text Available Autism spectrum disorder (ASD is a neurodevelopmental disorder that affects 1 in 68 children in the United States. Even though it is a common disorder, only two medications (Risperidone and Aripiprazole are approved by the U.S. Food and Drug Administration (FDA to treat symptoms associated with ASD. However these medications are approved to treat irritability, which is not a core symptom of ASD. A number of novel medications which have not been approved by the FDA to treat ASD have been used off-label in some studies to treat ASD symptoms, including medications approved for Alzheimer’s disease. Interestingly, some of these studies are high quality, double-blind, placebo-controlled (DBPC studies. This article systematically reviews studies published through April, 2014 which examined the use of Alzheimer’s medications in ASD, including donepezil (7 studies, 2 were DBPC, 5/7 reported improvements, galantamine (4 studies, 2 were DBPC, all reported improvements, rivastigmine (1 study reporting improvements, tacrine (1 study reporting improvements and memantine (9 studies, 1 was DBPC, 8 reported improvements. An evidence-based scale was used to rank each medication. Collectively, these studies reported improvements in expressive language and communication, receptive language, social interaction, irritability, hyperactivity, attention, eye contact, emotional lability, repetitive or self-stimulatory behaviors, motor planning, disruptive behaviors, obsessive-compulsive symptoms, lethargy, overall ASD behaviors and increased REM sleep. Reported side effects are reviewed and include irritability, gastrointestinal problems, verbal or behavioral regression, headaches, irritability, rash, tremor, sedation, vomiting, and speech problems. Both galantamine and memantine had sufficient evidence ranking for improving both core and associated symptoms of ASD. Given the lack of medications approved to treat ASD, further studies on novel medications, including

  3. Association of social anxiety disorder with depression and quality of life among medical undergraduate students.

    Science.gov (United States)

    Ratnani, Imran Jahangirali; Vala, Ashok Ukabhai; Panchal, Bharat Navinchandra; Tiwari, Deepak Sachchidanand; Karambelkar, Smruti S; Sojitra, Milankumar G; Nagori, Nidhi N

    2017-01-01

    Social anxiety disorder (SAD), (also known as social phobia), is characterized by intense fear of social interaction and often associated with social avoidance and impairments. There is high risk for depression, substance use disorder, and suicide among them. It is an observational, cross-sectional, single centered, questionnaire-based study assessing the frequency of SAD and depression and their possible association with quality of life among 290 consenting medical undergraduate students. Social Phobia Inventory (SPIN), Beck's Depression Inventory (BDI II), and the World Health Organization Quality of Life assessment scale (WHOQOL-BREF) were used to screen and assess severity of SAD, depression, and quality of life, respectively. The statistical analysis of proportions was done by Chi-square test, while the scores of SPIN, BDI II, and WHOQOL-BREF was compared using Mann-Whitney test or Kruskal-Wallis test followed by Dunn posttest multiple comparison, using GraphPad InStat version 3.06. Frequency of SAD is 11.37%, and depression is 8.96%. Females are more likely to experience SAD. Participants with SAD are more likely to experience depression ( P social fear ( P = 0.02). Participants staying away from their family are more likely to experience social anxiety in comparison to their peers ( P = 0.01). Severity of depression is correlated with severity of social anxiety (Spearman r = 0.4423 [0.3416-0.5329], P < 0.0001). Participants with SAD are more likely to experience depressive symptoms and have poor quality of life and vice versa.

  4. Association of social anxiety disorder with depression and quality of life among medical undergraduate students

    Directory of Open Access Journals (Sweden)

    Imran Jahangirali Ratnani

    2017-01-01

    Full Text Available Objective: Social anxiety disorder (SAD, (also known as social phobia, is characterized by intense fear of social interaction and often associated with social avoidance and impairments. There is high risk for depression, substance use disorder, and suicide among them. Subjects and Methods: It is an observational, cross-sectional, single centered, questionnaire-based study assessing the frequency of SAD and depression and their possible association with quality of life among 290 consenting medical undergraduate students. Social Phobia Inventory (SPIN, Beck's Depression Inventory (BDI II, and the World Health Organization Quality of Life assessment scale (WHOQOL-BREF were used to screen and assess severity of SAD, depression, and quality of life, respectively. The statistical analysis of proportions was done by Chi-square test, while the scores of SPIN, BDI II, and WHOQOL-BREF was compared using Mann–Whitney test or Kruskal–Wallis test followed by Dunn posttest multiple comparison, using GraphPad InStat version 3.06. Results: Frequency of SAD is 11.37%, and depression is 8.96%. Females are more likely to experience SAD. Participants with SAD are more likely to experience depression (P < 0.0001 and have poor quality of life (P = 0.01. Participants with depression have higher SPIN score (P < 0.0001 and poor quality of life (P < 0.0001. Females are more likely to experience social fear (P = 0.02. Participants staying away from their family are more likely to experience social anxiety in comparison to their peers (P = 0.01. Severity of depression is correlated with severity of social anxiety (Spearman r = 0.4423 [0.3416–0.5329], P < 0.0001. Conclusion: Participants with SAD are more likely to experience depressive symptoms and have poor quality of life and vice versa.

  5. Understanding the effects of stimulant medications on cognition in individuals with attention-deficit hyperactivity disorder: a decade of progress.

    Science.gov (United States)

    Swanson, James; Baler, Ruben D; Volkow, Nora D

    2011-01-01

    The use of stimulant drugs for the treatment of children with attention-deficit hyperactivity disorder (ADHD) is one of the most widespread pharmacological interventions in child psychiatry and behavioral pediatrics. This treatment is well grounded on controlled studies showing efficacy of low oral doses of methylphenidate and amphetamine in reducing the behavioral symptoms of the disorder as reported by parents and teachers, both for the cognitive (inattention and impulsivity) and non-cognitive (hyperactivity) domains. Our main aim is to review the objectively measured cognitive effects that accompany the subjectively assessed clinical responses to stimulant medications. Recently, methods from the cognitive neurosciences have been used to provide information about brain processes that underlie the cognitive deficits of ADHD and the cognitive effects of stimulant medications. We will review some key findings from the recent literature, and then offer interpretations of the progress that has been made over the past decade in understanding the cognitive effects of stimulant medication on individuals with ADHD.

  6. Facilitators and barriers to initiating change in medical intensive care unit survivors with alcohol use disorders: a qualitative study.

    Science.gov (United States)

    Clark, Brendan J; Jones, Jacqueline; Cook, Paul; Tian, Karen; Moss, Marc

    2013-10-01

    Alcohol abuse and dependence are collectively referred to as alcohol use disorders (AUD). An AUD is present in up to one third of patients admitted to an intensive care unit (ICU). We sought to understand the barriers and facilitators to change in ICU survivors with an AUD to provide a foundation upon which to tailor alcohol-related interventions. We used a qualitative approach with a broad constructivist framework, conducting semistructured interviews in medical ICU survivors with an AUD. Patients were included if they were admitted to 1 of 2 medical ICUs and were excluded if they refused participation, were unable to participate, or did not speak English. Digitally recorded and professionally transcribed interviews were analyzed using a general inductive approach and grouped into themes. Nineteen patients were included, with an average age of 51 (interquartile range, 36-51) years and an average Acute Physiology and Chronic Health Evaluation II score of 9 (interquartile range, 5-13); 68% were white, 74% were male, and the most common reason for admission was alcohol withdrawal (n=8). We identified 5 facilitators of change: empathy of the inpatient health care environment, recognition of accumulating problems, religion, pressure from others to stop drinking, and trigger events. We identified 3 barriers to change: missed opportunities, psychiatric comorbidity, and cognitive dysfunction. Social networks were identified as either a barrier or facilitator to change depending on the specific context. Alcohol-related interventions to motivate and sustain behavior change could be tailored to ICU survivors by accounting for unique barriers and facilitators. © 2013.

  7. Individual versus group female-specific cognitive behavior therapy for alcohol use disorder.

    Science.gov (United States)

    Epstein, Elizabeth E; McCrady, Barbara S; Hallgren, Kevin A; Gaba, Ayorkor; Cook, Sharon; Jensen, Noelle; Hildebrandt, Thomas; Holzhauer, Cathryn Glanton; Litt, Mark D

    2018-05-01

    To test group-based Female-Specific Cognitive Behavioral Therapy (G-FS-CBT) for women with Alcohol Use Disorder (AUD) against an individual Female-Specific Cognitive Behavioral Therapy (I-FS-CBT). This aims of this paper are to describe G-FS-CBT development, content, feasibility, acceptability, group process, engagement in treatment, and within- and post-treatment outcomes. Women with AUD (n=155) were randomly assigned to 12 manual-guided sessions of G-FS-CBT or I-FS-CBT; 138 women attended at least one treatment session. Women in G-FS-CBT attended fewer sessions (M=7.6) than women in I-FS-CBT (M=9.7; p<.001). Women in both conditions reported high satisfaction with the treatments. Independent coders rated high fidelity of delivery of both G-FS-CBT and I-FS-CBT. Therapeutic alliance with the therapist was high in both conditions, with I-FS-CBT being slightly but significantly higher than G-FS-CBT. In the first six weeks of treatment, women in both treatment conditions significantly reduced their percent drinking days (PDD) and percent heavy days drinking (PHD) by equivalent amounts, maintained through the rest of treatment and the 12month follow up with no treatment condition effects. Women reported significant improvement in all but one of the secondary outcomes during treatment; gains made during treatment in depression, anxiety, autonomy, and interpersonal problems were maintained during the follow-up period, while gains made during treatment in use of coping skills, self-efficacy for abstinence, self-care, and sociotropy deteriorated over follow up but remained improved compared to baseline. Findings support the feasibility, acceptability, and efficacy of a group format for female-specific CBT for AUD, a new 12-session, single gender, community friendly, group therapy with programming specifically for women. Similar, positive outcomes for individual and group treatment formats were found for drinking, mood, coping skills, self-confidence, interpersonal

  8. Development of a translational model to screen medications for cocaine use disorder II: Choice between intravenous cocaine and money in humans

    Science.gov (United States)

    Lile, Joshua A.; Stoops, William W.; Rush, Craig R.; Negus, S. Stevens; Glaser, Paul E. A.; Hatton, Kevin W.; Hays, Lon R.

    2016-01-01

    Background A medication for treating cocaine use disorder has yet to be approved. Laboratory-based evaluation of candidate medications in animals and humans is a valuable means to demonstrate safety, tolerability and initial efficacy of potential medications. However, animal-to-human translation has been hampered by a lack of coordination. Therefore, we designed homologous cocaine self-administration studies in rhesus monkeys (see companion article) and human subjects in an attempt to develop linked, functionally equivalent procedures for research on candidate medications for cocaine use disorder. Methods Eight (N=8) subjects with cocaine use disorder completed 12 experimental sessions in which they responded to receive money ($0.01, $1.00 and $3.00) or intravenous cocaine (0, 3, 10 and 30 mg/70 kg) under independent, concurrent progressive-ratio schedules. Prior to the completion of 9 choice trials, subjects sampled the cocaine dose available during that session and were informed of the monetary alternative value. Results The allocation of behavior varied systematically as a function of cocaine dose and money value. Moreover, a similar pattern of cocaine choice was demonstrated in rhesus monkeys and humans across different cocaine doses and magnitudes of the species-specific alternative reinforcers. The subjective and cardiovascular responses to IV cocaine were an orderly function of dose, although heart rate and blood pressure remained within safe limits. Conclusions These coordinated studies successfully established drug vs. non-drug choice procedures in humans and rhesus monkeys that yielded similar cocaine choice behavior across species. This translational research platform will be used in future research to enhance the efficiency of developing interventions to reduce cocaine use. PMID:27269368

  9. SU-F-E-16: A Specific Training Package for Medical Physicists in Support to Nuclear and Radiological Emergency Situations

    International Nuclear Information System (INIS)

    Meghzifene, A; Berris, T

    2016-01-01

    Purpose: To provide the professional medical physicists with adequate competencies and skills in order to help them get prepared to support Nuclear or Radiological Emergency (NRE) situations. Methods: Although clinical medical physicists working have in-depth knowledge in radiation dosimetry, including dose reconstruction and dose measurements, they are usually not involved in NRE situations. However, in a few instances where medical physicists were involved in NREs, it appeared that many lacked specific knowledge and skills that are required in such situations. This lack of specific knowledge and skills is probably due to the fact that most current medical physics curricula do not include a specific module on this topic. As a response to this finding, the IAEA decided to initiate a project to develop a specific training package to help prepare medical physicists to support NRE situations. The training package was developed with the kind support of the Government of Japan and in collaboration with Fukushima Medical University (FMU) and the National Institute of Radiological Sciences (NIRS). Results: The first International Workshop to test the training package was held in Fukushima, Japan in June 2015. It consisted of lectures, demonstrations, simulation, role play, and practical sessions followed by discussions. The training was delivered through 14 modules which were prepared with the support of 12 lecturers. A knowledge assessment test was done before the workshop, followed by the same test done at the end of the Workshop, to assess the knowledge acquired during the training. Conclusion: The Workshop was successfully implemented. The overall rating of the workshop by the participants was excellent and all participants reported that they acquired a good understanding of the main issues that are relevant to medical physics support in case of NRE situations. They are expected to disseminate the knowledge to other medical physicists in their countries.

  10. SU-F-E-16: A Specific Training Package for Medical Physicists in Support to Nuclear and Radiological Emergency Situations

    Energy Technology Data Exchange (ETDEWEB)

    Meghzifene, A; Berris, T [International Atomic Energy Agency, Vienna, Vienna (Austria)

    2016-06-15

    Purpose: To provide the professional medical physicists with adequate competencies and skills in order to help them get prepared to support Nuclear or Radiological Emergency (NRE) situations. Methods: Although clinical medical physicists working have in-depth knowledge in radiation dosimetry, including dose reconstruction and dose measurements, they are usually not involved in NRE situations. However, in a few instances where medical physicists were involved in NREs, it appeared that many lacked specific knowledge and skills that are required in such situations. This lack of specific knowledge and skills is probably due to the fact that most current medical physics curricula do not include a specific module on this topic. As a response to this finding, the IAEA decided to initiate a project to develop a specific training package to help prepare medical physicists to support NRE situations. The training package was developed with the kind support of the Government of Japan and in collaboration with Fukushima Medical University (FMU) and the National Institute of Radiological Sciences (NIRS). Results: The first International Workshop to test the training package was held in Fukushima, Japan in June 2015. It consisted of lectures, demonstrations, simulation, role play, and practical sessions followed by discussions. The training was delivered through 14 modules which were prepared with the support of 12 lecturers. A knowledge assessment test was done before the workshop, followed by the same test done at the end of the Workshop, to assess the knowledge acquired during the training. Conclusion: The Workshop was successfully implemented. The overall rating of the workshop by the participants was excellent and all participants reported that they acquired a good understanding of the main issues that are relevant to medical physics support in case of NRE situations. They are expected to disseminate the knowledge to other medical physicists in their countries.

  11. Statistical word learning in children with autism spectrum disorder and specific language impairment.

    Science.gov (United States)

    Haebig, Eileen; Saffran, Jenny R; Ellis Weismer, Susan

    2017-11-01

    Word learning is an important component of language development that influences child outcomes across multiple domains. Despite the importance of word knowledge, word-learning mechanisms are poorly understood in children with specific language impairment (SLI) and children with autism spectrum disorder (ASD). This study examined underlying mechanisms of word learning, specifically, statistical learning and fast-mapping, in school-aged children with typical and atypical development. Statistical learning was assessed through a word segmentation task and fast-mapping was examined in an object-label association task. We also examined children's ability to map meaning onto newly segmented words in a third task that combined exposure to an artificial language and a fast-mapping task. Children with SLI had poorer performance on the word segmentation and fast-mapping tasks relative to the typically developing and ASD groups, who did not differ from one another. However, when children with SLI were exposed to an artificial language with phonemes used in the subsequent fast-mapping task, they successfully learned more words than in the isolated fast-mapping task. There was some evidence that word segmentation abilities are associated with word learning in school-aged children with typical development and ASD, but not SLI. Follow-up analyses also examined performance in children with ASD who did and did not have a language impairment. Children with ASD with language impairment evidenced intact statistical learning abilities, but subtle weaknesses in fast-mapping abilities. As the Procedural Deficit Hypothesis (PDH) predicts, children with SLI have impairments in statistical learning. However, children with SLI also have impairments in fast-mapping. Nonetheless, they are able to take advantage of additional phonological exposure to boost subsequent word-learning performance. In contrast to the PDH, children with ASD appear to have intact statistical learning, regardless of

  12. Specific Learning Disorders: A Look Inside Children's and Parents' Psychological Well-Being and Relationships.

    Science.gov (United States)

    Bonifacci, Paola; Storti, Michele; Tobia, Valentina; Suardi, Alessandro

    2016-09-01

    Despite their ascertained neurobiological origin, specific learning disorders (SLD) often have been found to be associated with some emotional disturbances in children, and there is growing interest in the environmental and contextual variables that may modulate children's developmental trajectories. The present study was aimed at evaluating the psychological profile of parents and children and the relationships between their measures. Parents of children with SLD (17 couples, 34 participants) and parents of children with typical development (17 couples, 34 participants) were administered questionnaires assessing parenting styles, reading history, parenting stress, psychopathological indexes, and evaluations of children's anxiety and depression. Children (N = 34, 10.7 ± 1.2 years) were assessed with self-evaluation questionnaires on anxiety, depression, and self-esteem and with a scale assessing their perception of parents' qualities. Results showed that parents of children with SLD have higher parental distress, poorer reading history, and different parenting styles compared to parents of children with TD; there were no differences in psychopathological indexes. The SLD group also rated their children as more anxious and depressed. Children with SLD had lower scholastic and interpersonal self-esteem, but they report ratings of parents' qualities similar to those of TD children. Relationships between parents' and children's measures were further explored. Implications for research and practice are discussed. © Hammill Institute on Disabilities 2015.

  13. Investigation of distinctive characteristics of children with specific learning disorder and borderline intellectual functioning

    Directory of Open Access Journals (Sweden)

    Selcuk Ozkan

    Full Text Available Abstract Background Borderline intelligence function (BIF and specific learning disorder (SLD are common diagnoses in children who are brought up for learning problems and school failure. Objective The aim of our study was to determine whether there were distinctive aspects of cognitive testing routinely used in evaluating SLD and BIF and investigate emotion regulation skills and minor neurologic symptoms. Method Sixty children (30 SLD and 30 BIF who are currently attending primary school are selected for study. Visual Aural Digit Span Test – Form B, Gessel Figure Drawing Test, Bender Gestalt Visual Motor Perception Test, WISC-R, Emotion Regulation Scale (ERS and Neurological Evaluation Scale (NES was administered. Results There was no statistically significant difference between groups in cognitive tests. The emotional regulation ability measured by the emotional regulation subscale was better in the SLD group than the BIF group (p = 0.014. In the NES, sensory integration (p = 0.008, motor coordination (p = 0.047 and other (p < 0.001 subscales showed higher scores in the BIF group. Discussion It has been shown that cognitive tests don’t have distinguishing features in the evaluation of SLD and BIF. Emotion regulation subscale score of ERS and sensory integration, motor coordination, and total scores of NES can be used in both discrimination of groups.

  14. Statistical Learning in Specific Language Impairment and Autism Spectrum Disorder: A Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Rita Obeid

    2016-08-01

    Full Text Available Impairments in statistical learning might be a common deficit among individuals with Specific Language Impairment (SLI and Autism Spectrum Disorder (ASD. Using meta-analysis, we examined statistical learning in SLI (14 studies, 15 comparisons and ASD (13 studies, 20 comparisons to evaluate this hypothesis. Effect sizes were examined as a function of diagnosis across multiple statistical learning tasks (Serial Reaction Time, Contextual Cueing, Artificial Grammar Learning, Speech Stream, Observational Learning, Probabilistic Classification. Individuals with SLI showed deficits in statistical learning relative to age-matched controls g = .47, 95% CI [.28, .66], p < .001. In contrast, statistical learning was intact in individuals with ASD relative to controls, g = –.13, 95% CI [–.34, .08], p = .22. Effect sizes did not vary as a function of task modality or participant age. Our findings inform debates about overlapping social-communicative difficulties in children with SLI and ASD by suggesting distinct underlying mechanisms. In line with the procedural deficit hypothesis (Ullman & Pierpont, 2005, impaired statistical learning may account for phonological and syntactic difficulties associated with SLI. In contrast, impaired statistical learning fails to account for the social-pragmatic difficulties associated with ASD.

  15. Detection of activated platelets using activation-specific monoclonal antibody (SZ-51) in clinical disorders

    International Nuclear Information System (INIS)

    Wu Guoxin; Li Fugang; Li Jianyong; Ruan Changgeng

    1991-10-01

    A direct test for activated platelets in whole blood was developed by radioimmunoassay with 125 I labeled SZ-51, an antibody specific for an α-granule membrane protein (GMP-140) that associates with the platelet surface during secretion. The assay had sufficient sensitivity to detect as few as 2% activated platelets. In 50 normal subjects, minimal GMP-140 molecules per platelet were expressed on the surface of circulating platelets. Ten patients undergoing cardiopulmonary bypass had transiently increased expression of GMP-140 molecules during the bypass procedure, especially at the end of bypass. Evaluation of 18 patients with epidemic hemorrhagic fever (EHF) has shown that the number of GMP-140 molecules on the platelet surface was closely related to the four different phases of EHF. In six patients suffered from acute myocardial infarction (AMI), the number of GMP-140 molecules changed with the procession of AMI and the highest occurred 48 h after AMI. The GMP-140 molecules were also increased in patients with asthma attack (n = 14), but not in patients with idiopathic thrombocytopenic purpura (n = 11) and diabetic mellitus (n = 48). Taken together, these studies suggest that activated platelet can be reliably measured in whole blood using radiolabeled SZ-51 antibody and the detection of activated platelets is potentially useful in identifying patients with certain thrombotic disorders and others

  16. Single Nucleotide Polymorphisms of Gene and Association with Non-specific Digestive Disorder in Rabbit

    Directory of Open Access Journals (Sweden)

    Yun-Fu Liu

    2013-08-01

    Full Text Available The NLRP12 (NLR family, pyrin domain containing 12 serves as a suppressor factor in the inflammatory response and protects the host against inflammation-induced damage. In the present study, we aimed to study the polymorphisms of NLRP12 gene and its association with susceptibility to non-specific digestive disorder (NSDD in rabbits. We re-sequenced the entire coding region of the rabbit NLRP12 gene and detected a total of 19 SNPs containing 14 synonymous and five non-synonymous variations. Among them, the coding SNP (c.1682A>G, which would carry a potential functional implication, was subsequently subjected to genotyping for case-control association study (272 cases and 267 controls. The results revealed that allele A was significantly protective against NSDD with an odds ratio value of 0.884 (95% confidence interval, 0.788 to 0.993; p = 0.038. We also experimentally induced NSDD in growing rabbits by feeding a fibre-deficient diet and subsequently investigated NLRP12 mRNA expression. The mRNA expression of NLRP12 in healthy status was significantly higher than that in severe NSDD (p = 0.0016. The highest expression was observed in individuals carrying the protective genotype AA (p = 0.0108. These results suggested that NLRP12 was significantly associated with the NSDD in rabbits. However, the precise molecular mechanism of NLRP12 involving in the development of rabbit NSDD requires further research.

  17. Visceral and somatic disorders: tissue softening with frequency-specific microcurrent.

    Science.gov (United States)

    McMakin, Carolyn R; Oschman, James L

    2013-02-01

    Frequency-specific microcurrent (FSM) is an emerging technique for treating many health conditions. Pairs of frequencies of microampere-level electrical stimulation are applied to particular places on the skin of a patient via combinations of conductive graphite gloves, moistened towels, or gel electrode patches. A consistent finding is a profound and palpable tissue softening and warming within seconds of applying frequencies appropriate for treating particular conditions. Similar phenomena are often observed with successful acupuncture, cranial-sacral, and other energy-based techniques. This article explores possible mechanisms involved in tissue softening. In the 1970s, neuroscientist and osteopathic researcher Irvin Korr developed a "γ-loop hypothesis" to explain the persistence of increased systemic muscle tone associated with various somatic dysfunctions. This article summarizes how physiologists, neuroscientists, osteopaths, chiropractors, and fascial researchers have expanded on Korr's ideas by exploring various mechanisms by which injury or disease increase local muscle tension or systemic muscle tone. Following on Korr's hypothesis, it is suggested that most patients actually present with elevated muscle tone or tense areas due to prior traumas or other disorders, and that tissue softening indicates that FSM or other methods are affecting the cause of their pathophysiology. The authors believe this concept and the research it has led to will be of interest to a wide range of energetic, bodywork, and movement therapists.

  18. Avoidant/Restrictive Food Intake Disorder in an 11-Year Old South American Boy: Medical and Cultural Challenges.

    Science.gov (United States)

    Schermbrucker, Jonah; Kimber, Melissa; Johnson, Natasha; Kearney, Sarah; Couturier, Jennifer

    2017-07-01

    Avoidant/Restrictive Food Intake Disorder (ARFID) is new in the DSM-5, replacing the DSM-IV-TR diagnosis of Feeding Disorder of Infancy or Early Childhood. ARFID has no age criterion, and therefore addresses eating disturbances across the lifespan. This report illustrates the case of an 11-year-old boy of Colombian ancestry with ARFID and explores the role of culture in the diagnosis of ARFID. To date, literature describing this disorder is limited. ARFID is often seen in the child and adolescent population and can have significant medical consequences, including weight loss, hemodynamic instability, and growth retardation. Studies examining the potential cultural challenges of diagnosing and treating ARFID would benefit patients, as well as health professionals working in primary care, pediatrics, and psychiatry. This paper is intended to inform the reader about this multifaceted disorder, and to generate interest for future research.

  19. Reinforcement and stimulant medication ameliorate deficient response inhibition in children with Attention-Deficit/Hyperactivity Disorder

    Science.gov (United States)

    Rosch, Keri S.; Fosco, Whitney D.; Pelham, William E.; Waxmonsky, James G.; Bubnik, Michelle G.; Hawk, Larry W.

    2015-01-01

    This study examined the degree to which reinforcement, stimulant medication, and their combination impact response inhibition in children with Attention-Deficit/Hyperactivity Disorder (ADHD). Across three studies, participants with ADHD (n=111, 25 girls) and typically-developing (TD) controls (n=33, 6 girls) completed a standard version of the stop signal task (SST) and/or a reinforcement-manipulation SST with performance-contingent points. In two of these studies, these tasks were performed under placebo or 0.3 and 0.6 mg/kg methylphenidate (MPH) conditions. Cross-study comparisons were conducted to test hypotheses regarding the separate and combined effects of reinforcement and methylphenidate on response inhibition among children with ADHD relative to TD controls. Baseline response inhibition was worse among children with ADHD compared to controls. MPH produced dose-related improvements in response inhibition in children with ADHD; compared to non-medicated TD controls, 0.3 mg/kg MPH normalized deficient response inhibition, and 0.6 mg/kg MPH resulted in better inhibition in children with ADHD. Reinforcement improved response inhibition to a greater extent for children with ADHD than for TD children, normalizing response inhibition. The combination of MPH and reinforcement improved response inhibition among children with ADHD compared to reinforcement alone and MPH alone, also resulting in normalization of response inhibition despite repeated task exposure. Deficient response inhibition commonly observed in children with ADHD is significantly improved with MPH and/or reinforcement, normalizing inhibition relative to TD children tested under standard conditions. PMID:25985978

  20. Patient-Centered Medical Home and Family Burden in Attention-Deficit Hyperactivity Disorder.

    Science.gov (United States)

    Ronis, Sarah D; Baldwin, Constance D; Blumkin, Aaron; Kuhlthau, Karen; Szilagyi, Peter G

    2015-01-01

    Attention-deficit hyperactivity disorder (ADHD) can impair child health and functioning, but its effects on the family's economic burden are not well understood. The authors assessed this burden in US families of children with ADHD, and the degree to which access to a patient-centered medical home (PCMH) might reduce this burden. We conducted cross-sectional analyses of 2005-2006 and 2009-2010 National Surveys of Children with Special Health Care Needs, focusing on families of children with ADHD. They defined family economic burden as (1) family financial problems (annual expenses for the child's health care or illness-related financial problems for the family) and/or (2) family employment problems (job loss, work time loss, or failure to change jobs to avoid insurance loss). Relative risk models assessed associations between PCMH and family economic burden, adjusted for child age, sex, ethnicity, ADHD severity, poverty status, caregiver education, and insurance. In 2009, 26% of families reported financial problems because of the child's ADHD, 2.1% reported out-of-pocket expenses >5% of income, and 36% reported employment problems. Only 38% reported care that met all 5 criteria for a PCMH (similar to rates in 2005-2006). In multivariable analysis, care in a PCMH was associated with 48% lower relative risk (RR) of financial problems (RR = 0.52, p family-centered care and care coordination were more strongly associated with lower burden. The economic burdens of families with ADHD are significant but may be alleviated by family-centered care and care coordination in a medical home.

  1. Medications development for substance-use disorders: contextual influences (dis)incentivizing pharmaceutical-industry positioning.

    Science.gov (United States)

    Janero, David R

    2014-11-01

    The significant contribution of substance-use disorders (SUDs) to the global-disease burden and associated unmet medical needs has not engendered a commensurate level of pharma-industry research and development (R&D) for novel SUD therapeutics invention. Analysis of contextual factors shaping this position suggests potential routes toward incentivizing R&D commitment for that purpose. This article considers multiple primary factors that have consorted to disincentivize pharma industry's operating in the SUD space: ill-understood pathology; variegated treatments and patient profiles; involved clinical trials; and - with particular reference to SUDs-negative cultural/business stigmas and shallow commercial precedent. Industry incentivization for SUD drug innovation requires progress on several fronts, including: translational experimental data and systems; personalized, holistic SUD treatment approaches; interactions among pharma, nonindustry constituencies, and the medical profession with vested interests in countering negative stereotypes and expanding SUD treatment options; and public-private alliances focused on improving SUD pharmacotherapy. Given the well-entrenched business stance whereby the prospect of future profits in major markets largely determines drug-company R&D investment trajectory, strategic initiatives offering substantial reductions in the risks and opportunity (i.e., time and money) costs associated with SUD drug discovery are likely to be the most potent drivers for encouraging mainstream industry positioning in this therapeutic area. Such initiatives could originate from front-loaded R&D operational and back-loaded patent, regulatory, marketing and health-care policy reforms. These may be too involved and protracted for the turbulent pharmaceutical industry to entertain amid its recent retrenchment from psychiatric/CNS diseases and intense pressures to increase productivity and shareholder value.

  2. Prescription procedures in medication for relapse prevention after inpatient treatment for alcohol use disorders in Switzerland.

    Science.gov (United States)

    Buri, Caroline; Moggi, Franz; Giovanoli, Anna; Strik, Werner

    2007-01-01

    In randomized controlled trials with high internal validity, pharmacotherapy using acamprosate, naltrexone, and, to a somewhat lesser extent, disulfiram has proved effective in preventing relapse in patients with alcohol use disorders (AUD). There remains, however, a paucity of studies with sufficient external validity in which the effectiveness of pharmacotherapy in clinical practice is investigated. This study aimed to make a contribution to close this gap in research. In this naturalistic, prospective study, a comparison on indices of substance use, psychiatric symptoms, and treatment service utilization was carried out using samples of 92 patients who received pharmacotherapy and 323 patients who did not receive pharmacotherapy following discharge from 12 residential AUD programmes (index stay). Patients that received pharmacotherapy were more likely to use alcohol during the index stay and at the 1-year follow-up. Moreover, this patient group more readily utilized treatment services during a 2-year period prior to and a 1-year period following index stay than patients who were not given pharmacotherapy. Nevertheless, when pharmacotherapy was prescribed before first post-treatment alcohol use, it was associated with delay of alcohol use, fewer relapses, and a reduced need for inpatient treatment. In many cases, however, medication was not prescribed until alcohol use and relapse had occurred. The length of time to first alcohol use was longer, and the cumulative abstinence rate higher, for disulfiram than for acamprosate, the latter being generally prescribed for more severely alcohol-dependent patients. There is a need for further studies to probe the reasons why medication for relapse prevention is not prescribed upon discharge from residential treatment and for less severely alcohol-dependent patients.

  3. Positive posttraumatic stress disorder screens among first-time medical cannabis patients: prevalence and association with other substance use.

    Science.gov (United States)

    Bohnert, Kipling M; Perron, Brian E; Ashrafioun, Lisham; Kleinberg, Felicia; Jannausch, Mary; Ilgen, Mark A

    2014-10-01

    Twenty-one states and the District of Columbia have passed legislation allowing for the use of medical cannabis for those individuals with qualifying medical conditions, which include posttraumatic stress disorder (PTSD) for a growing number of states. Little information is available regarding PTSD among medical cannabis patients. This study seeks to provide initial data on this topic by examining the prevalence and correlates of positive PTSD screens among a sample of patients seeking medical cannabis certification for the first time (n=186). Twenty-three percent (42/186; 95% confidence interval [CI] =17%-29%) of the patients in the study sample screened positive for PTSD. Moreover, the group that screened positive for PTSD had higher percentages of lifetime prescription opioid, cocaine, prescription sedative, and street opioid use, as well as a higher percentage of recent prescription sedative use, than the group that screened negative for PTSD. These findings highlight the relatively common use of other substances among medical cannabis patients with significant PTSD symptoms, even when compared with other patients seeking medical cannabis for the first time. As a growing number of states include PTSD among the list of qualifying medical conditions for medical cannabis, additional research is needed to better characterize the longitudinal relationship between medical cannabis use and PTSD symptoms. Published by Elsevier Ltd.

  4. [Specific impairments and neurodevelopmental disorders in 3- to 12-year olds].

    Science.gov (United States)

    Forgeot D'Arc, Baudouin; Dubail-Sbasnik, Christelle; Legay, Vassilissa

    2011-04-01

    Difficulties in scholarship in children are very frequent reasons for consultation in general practice. General practitioners' role is primordial in screening, diagnosis and management in these complex and long-lasting disorders. Learning difficulties often stem from developmental disorders, which are frequently co-occurring and may be associated with emotional and behavioural disorders. They often persist in adulthood, but may benefit from active management associating training interventions and school accommodations.

  5. The association of an inability to form and maintain close relationships due to a medical condition with anxiety and depressive disorders.

    Science.gov (United States)

    Simning, Adam; Seplaki, Christopher L; Conwell, Yeates

    2016-03-15

    While low social support is a risk factor for mental illness, anxiety and depression's relationship with social impairment specifically resulting from a medical condition is poorly understood. We hypothesize that when a medical illness makes it difficult for people to form and maintain close relationships with others, they will be at increased risk for anxiety and depression. Two nationally representative surveys, the National Comorbidity Survey-Replication and National Latino and Asian American Study, included 6805 adults with at least one medical illness and information on social impairment attributed to a medical condition. The Composite International Diagnostic Interview evaluated a 12-month history of anxiety and depressive disorders. 8.2% of our sample had at least moderate difficulty in forming and maintaining close relationships due to a medical condition. In bivariate analyses, younger age, Latino ethnicity, less education, worse financial status, more chronic illnesses, physical health and discomfort, and problems with mobility, home management, and self-care were associated with this social impairment. In multivariable analyses accounting for possible confounders, there was a dose-dependent relationship between social impairment and the prevalence of anxiety and depression. Data are cross-sectional and our analyses are therefore unable to determine cause-and-effect relationships. Among adults with one or more medical conditions, social impairment attributed to medical illness was associated with a significantly greater odds of anxiety and depression. Further clarification of this relationship could inform more targeted, personalized interventions to prevent and/or alleviate mental illness in those with chronic medical conditions. Copyright © 2016 Elsevier B.V. All rights reserved.

  6. Mobile Software as a Medical Device (SaMD) for the Treatment of Epilepsy: Development of Digital Therapeutics Comprising Behavioral and Music-Based Interventions for Neurological Disorders.

    Science.gov (United States)

    Afra, Pegah; Bruggers, Carol S; Sweney, Matthew; Fagatele, Lilly; Alavi, Fareeha; Greenwald, Michael; Huntsman, Merodean; Nguyen, Khanhly; Jones, Jeremiah K; Shantz, David; Bulaj, Grzegorz

    2018-01-01

    Digital health technologies for people with epilepsy (PWE) include internet-based resources and mobile apps for seizure management. Since non-pharmacological interventions, such as listening to specific Mozart's compositions, cognitive therapy, psychosocial and educational interventions were shown to reduce epileptic seizures, these modalities can be integrated into mobile software and delivered by mobile medical apps as digital therapeutics. Herein, we describe: (1) a survey study among PWE about preferences to use mobile software for seizure control, (2) a rationale for developing digital therapies for epilepsy, (3) creation of proof-of-concept mobile software intended for use as an adjunct digital therapeutic to reduce seizures, and (4) broader applications of digital therapeutics for the treatment of epilepsy and other chronic disorders. A questionnaire was used to survey PWE with respect to preferred features in a mobile app for seizure control. Results from the survey suggested that over 90% of responders would be interested in using a mobile app to manage their seizures, while 75% were interested in listening to specific music that can reduce seizures. To define digital therapeutic for the treatment of epilepsy, we designed and created a proof-of-concept mobile software providing digital content intended to reduce seizures. The rationale for all components of such digital therapeutic is described. The resulting web-based app delivered a combination of epilepsy self-care, behavioral interventions, medication reminders and the antiseizure music, such as the Mozart's sonata K.448. To improve long-term patient engagement, integration of mobile medical app with music and multimedia streaming via smartphones, tablets and computers is also discussed. This work aims toward development and regulatory clearance of software as medical device (SaMD) for seizure control, yielding the adjunct digital therapeutic for epilepsy, and subsequently a drug-device combination

  7. Adolescent eating disorder behaviours and cognitions: gender-specific effects of child, maternal and family risk factors

    Science.gov (United States)

    Micali, N.; De Stavola, B.; Ploubidis, G.; Simonoff, E.; Treasure, J.; Field, A. E.

    2015-01-01

    Background Eating disorder behaviours begin in adolescence. Few longitudinal studies have investigated childhood risk and protective factors. Aims To investigate the prevalence of eating disorder behaviours and cognitions and associated childhood psychological, physical and parental risk factors among a cohort of 14-year-old children. Method Data were collected from 6140 boys and girls aged 14 years. Gender-stratified models were used to estimate prospective associations between childhood body dissatisfaction, body mass index (BMI), self-esteem, maternal eating disorder and family economic disadvantage on adolescent eating disorder behaviours and cognitions. Results Childhood body dissatisfaction strongly predicted eating disorder cognitions in girls, but only in interaction with BMI in boys. Higher self-esteem had a protective effect, particularly in boys. Maternal eating disorder predicted body dissatisfaction and weight/shape concern in adolescent girls and dieting in boys. Conclusions Risk factors for eating disorder behaviours and cognitions vary according to gender. Prevention strategies should be gender-specific and target modifiable predictors in childhood and early adolescence. PMID:26206865

  8. Preoccupied Attachment and Emotional Dysregulation: Specific Aspects of Borderline Personality Disorder or General Dimensions of Personality Pathology?

    Science.gov (United States)

    Scott, Lori N.; Kim, Yookyung; Nolf, Kimberly A.; Hallquist, Michael N.; Wright, Aidan G.C.; Stepp, Stephanie D.; Morse, Jennifer Q.; Pilkonis, Paul A.

    2013-01-01

    Emotional dysregulation and impaired attachment are seen by many clinical researchers as central aspects of borderline personality disorder (BPD). Alternatively, these constructs may represent general impairments in personality that are nonspecific to BPD. Using multitrait-multimethod models, we examined the strength of associations among preoccupied attachment, difficulties with emotion regulation, BPD features, and features of two other personality disorders (i.e., antisocial and avoidant) in a combined psychiatric outpatient and community sample of adults. Results suggested that preoccupied attachment and difficulties with emotion regulation shared strong positive associations with each other and with each of the selected personality disorders. However, preoccupied attachment and emotional dysregulation were more strongly related to BPD features than to features of other personality disorders. Our findings suggest that although impairments in relational and emotional domains may underlie personality pathology in general, preoccupied attachment and emotional dysregulation also have specificity for understanding core difficulties in those with BPD. PMID:23586934

  9. Preoccupied attachment and emotional dysregulation: specific aspects of borderline personality disorder or general dimensions of personality pathology?

    Science.gov (United States)

    Scott, Lori N; Kim, Yookyung; Nolf, Kimberly A; Hallquist, Michael N; Wright, Aidan G C; Stepp, Stephanie D; Morse, Jennifer Q; Pilkonis, Paul A

    2013-08-01

    Emotional dysregulation and impaired attachment are seen by many clinical researchers as central aspects of borderline personality disorder (BPD). Alternatively, these constructs may represent general impairments in personality that are nonspecific to BPD. Using multitraitmultimethod models, the authors examined the strength of associations among preoccupied attachment, difficulties with emotion regulation, BPD features, and features of two other personality disorders (i.e., antisocial and avoidant) in a combined psychiatric outpatient and community sample of adults. Results suggested that preoccupied attachment and difficulties with emotion regulation shared strong positive associations with each other and with each of the selected personality disorders. However, preoccupied attachment and emotional dysregulation were more strongly related to BPD features than to features of other personality disorders. Findings suggest that although impairments in relational and emotional domains may underlie personality pathology in general, preoccupied attachment and emotional dysregulation also have specificity for understanding core difficulties in those with BPD.

  10. Making reasonable decisions: a qualitative study of medical decision making in the care of patients with a clinically significant haemoglobin disorder.

    Science.gov (United States)

    Crowther, Helen J; Kerridge, Ian

    2015-10-01

    Therapies utilized in patients with clinically significant haemoglobin disorders appear to vary between clinicians and units. This study aimed to investigate the processes of evidence implementation and medical decision making in the care of such patients in NSW, Australia. Using semi-structured interviews, 11 haematologists discussed their medical decision-making processes with particular attention paid to the use of published evidence. Transcripts were thematically analysed by a single investigator on a line-by-line basis. Decision making surrounding the care of patients with significant haemoglobin disorders varied and was deeply contextual. Three main determinants of clinical decision making were identified - factors relating to the patient and to their illness, factors specific to the clinician and the institution in which they were practising and factors related to the notion of evidence and to utility and role of evidence-based medicine in clinical practice. Clinicians pay considerable attention to medical decision making and evidence incorporation and attempt to tailor these to particular patient contexts. However, the patient context is often inferred and when discordant with the clinician's own contexture can lead to discomfort with decision recommendations. Clinicians strive to improve comfort through the use of experience and trustworthy evidence. © 2015 John Wiley & Sons, Ltd.

  11. [Gender-specific evaluation of student's career planning during medical study in terms of orthopaedic trauma].

    Science.gov (United States)

    Mooij, S C; Antony, P; Ruesseler, M; Pfeifer, R; Drescher, W; Simon, M; Pape, H-C; Knobe, M

    2011-08-01

    Due to recent changes in the medical licencing act as well as to the introduction of a new model-course programme for medical studies, careers in medicine have become increasingly more attractive. However, there is still a dramatic shortage in younger generation physicians, especially within the surgical fields. The goal of this cross-sectional study was the gender-specific assessment of the ideal career wishes of students during medical school, with a focus being placed in orthopaedic trauma surgery. During the winter semester of 2010/2011 an online questionnaire (www.surveymonkey.com) was created for students enrolled in their 3rd to 12th semester (n=887). The questionnaire consisted of 50 questions [Likert scale (LS); 5 = agree, 1 = disagree] along with 10 free response questions. The scope of these questions ranged from personal career goals, within the context of their learning environment, to general life goals and planning. With regard to career choice, a differentiation was made between students' ideal career choices/subjects (IS), which were based solely on personal affinity, and so-called reality-based subjects (RS), which students considered more practical and to which they were more likely to apply in the future. The response rate was 36,4% (n=323, 23,4 years, 6.3 semesters, 226 [70.0%] female [f] and 97 [30.0%] male [m]). A total of 206 students (63.8%; m=55.7% vs. f=66.7%; p=0.047) were able to pinpoint an IS, this percentage increased with increasing semester number (p=0.048). Overall, 29.1% of students indicated that their IS lay in the field of orthopaedic trauma, while 20.0% of men and 19.1% of women saw it as a realistic career path (RS). Throughout the course of their studies, from the 3rd semester to their practical year, a declining tendency was observed regarding the agreement between ideal and realistic career paths. Particularly evident was a decreasing interest in the field of orthopaedic trauma, beginning around the 9th semester and

  12. Speech disorders in Parkinson's disease: early diagnostics and effects of medication and brain stimulation.

    Science.gov (United States)

    Brabenec, L; Mekyska, J; Galaz, Z; Rektorova, Irena

    2017-03-01

    Hypokinetic dysarthria (HD) occurs in 90% of Parkinson's disease (PD) patients. It manifests specifically in the areas of articulation, phonation, prosody, speech fluency, and faciokinesis. We aimed to systematically review papers on HD in PD with a special focus on (1) early PD diagnosis and monitoring of the disease progression using acoustic voice and speech analysis, and (2) functional imaging studies exploring neural correlates of HD in PD, and (3) clinical studies using acoustic analysis to evaluate effects of dopaminergic medication and brain stimulation. A systematic literature search of articles written in English before March 2016 was conducted in the Web of Science, PubMed, SpringerLink, and IEEE Xplore databases using and combining specific relevant keywords. Articles were categorized into three groups: (1) articles focused on neural correlates of HD in PD using functional imaging (n = 13); (2) articles dealing with the acoustic analysis of HD in PD (n = 52); and (3) articles concerning specifically dopaminergic and brain stimulation-related effects as assessed by acoustic analysis (n = 31); the groups were then reviewed. We identified 14 combinations of speech tasks and acoustic features that can be recommended for use in describing the main features of HD in PD. While only a few acoustic parameters correlate with limb motor symptoms and can be partially relieved by dopaminergic medication, HD in PD seems to be mainly related to non-dopaminergic deficits and associated particularly with non-motor symptoms. Future studies should combine non-invasive brain stimulation with voice behavior approaches to achieve the best treatment effects by enhancing auditory-motor integration.

  13. Resting State Brain Network Disturbances Related to Hypomania and Depression in Medication-Free Bipolar Disorder.

    Science.gov (United States)

    Spielberg, Jeffrey M; Beall, Erik B; Hulvershorn, Leslie A; Altinay, Murat; Karne, Harish; Anand, Amit

    2016-12-01

    Research on resting functional brain networks in bipolar disorder (BP) has been unable to differentiate between disturbances related to mania or depression, which is necessary to understand the mechanisms leading to each state. Past research has also been unable to elucidate the impact of BP-related network disturbances on the organizational properties of the brain (eg, communication efficiency). Thus, the present work sought to isolate network disturbances related to BP, fractionate these into components associated with manic and depressive symptoms, and characterize the impact of disturbances on network function. Graph theory was used to analyze resting functional magnetic resonance imaging data from 60 medication-free patients meeting the criteria for BP and either a current hypomanic (n=30) or depressed (n=30) episode and 30 closely age/sex-matched healthy controls. Correction for multiple comparisons was carried out. Compared with controls, BP patients evidenced hyperconnectivity in a network involving right amygdala. Fractionation revealed that (hypo)manic symptoms were associated with hyperconnectivity in an overlapping network and disruptions in the brain's 'small-world' network organization. Depressive symptoms predicted hyperconnectivity in a network involving orbitofrontal cortex along with a less resilient global network organization. Findings provide deeper insight into the differential pathophysiological processes associated with hypomania and depression, along with the particular impact these differential processes have on network function.

  14. Seeing the doctor without fear: www.doctortea.org for the desensitization for medical visits in Autism Spectrum Disorders.

    Science.gov (United States)

    Boada, Leticia; Parellada, Mara

    Doctor Tea is an online website designed to facilitate medical visits for those with autism spectrum disorder and other disabilities. People diagnosed with autism not only have greater medical needs than the general population, but also have particular characteristics that are often not accommodated by medical services. This lack of medical accommodation often creates a very complicated, and sometimes traumatic experience, when visiting medical facilities. Individuals with autism have great difficulty understanding social situations and contexts, such as medical tests or consultations, as well as difficulty in tolerating new situations and atypical sensory thresholds. Doctor Tea aims to reduce anxiety before medical consultations and procedures from a safe and well-known environment (school, home, etc.). The website, www.doctortea.org, provides information and materials (videos, cartoon, 3D animations, pictogram sequences, etc.) about the most frequent medical procedures and practices for patients with autism. The website also offers information to the doctors and families of patients with autism about the most common medical problems associated with autism. A total of 17,199 different users visited the website during 2015, with a total of 23,348 online visitors from more than 70 different countries since the website's release in November 2014. The familiarisation with the medical procedures and its environment appears to decrease the anxiety in patients with disabilities during medical visits, as well as optimising the effectiveness of their medical visits and tests. Copyright © 2016 SEP y SEPB. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. The use of psychotropic medication in patients with emotionally unstable personality disorder under the care of UK mental health services.

    Science.gov (United States)

    Paton, Carol; Crawford, Michael J; Bhatti, Sumera F; Patel, Maxine X; Barnes, Thomas R E

    2015-04-01

    Guideline recommendations for the pharmacologic treatment of personality disorder lack consensus, particularly for emotionally unstable personality disorder (EUPD), and there is limited information on current prescribing practice in the United Kingdom. To characterize the nature and quality of current prescribing practice for personality disorder across the United Kingdom, as part of a quality improvement program. A cross-sectional survey of self-selected psychiatric services providing care for adults with personality disorder (ICD-10 criteria) was conducted. Data were collected during May 2012. Of 2,600 patients with a diagnosis of personality disorder, more than two-thirds (68%) had a diagnosis of EUPD. Almost all (92%) patients in the EUPD subgroup were prescribed psychotropic medication, most commonly an antidepressant or antipsychotic, principally for symptoms and behaviors that characterize EUPD, particularly affective dysregulation. Prescribing patterns were similar between those who had a diagnosed comorbid mental illness and those who had EUPD alone, but the latter group was less likely to have had their medication reviewed over the previous year, particularly with respect to tolerability (53% vs 43%). The use of psychotropic medication in EUPD in the United Kingdom is largely outside the licensed indications. Whether the treatment target is identified as intrinsic symptoms of EUPD or comorbid mental illness may depend on the diagnostic threshold of individual clinicians. Compared with prescribing for EUPD where there is judged to be a comorbid mental illness, the use of off-label medication for EUPD alone is less systematically reviewed and monitored, so opportunities for learning may be lost. Treatment may be continued long term by default. © Copyright 2015 Physicians Postgraduate Press, Inc.

  16. Developing scales measuring disorder-specific intolerance of uncertainty (DSIU) : a new perspective on transdiagnostic

    NARCIS (Netherlands)

    Thibodeau, Michel A; Carleton, R Nicholas; McEvoy, Peter M; Zvolensky, Michael J; Brandt, Charles P; Boelen, Paul A; Mahoney, Alison E J; Deacon, Brett J; Asmundson, Gordon J G

    Intolerance of uncertainty (IU) is a construct of growing prominence in literature on anxiety disorders and major depressive disorder. Existing measures of IU do not define the uncertainty that respondents perceive as distressing. To address this limitation, we developed eight scales measuring

  17. Parenting Practices and Attention-Deficit/Hyperactivity Disorder: New Findings Suggest Partial Specificity of Effects

    Science.gov (United States)

    Ellis, Brandi; Nigg, Joel

    2009-01-01

    The relation between attention deficit hyperactivity disorder (ADHD) and parenting practices is examined by assessing 182 children for ADHD and non ADHD status through parent semistructured clinical interview. Results show that maternal inconsistent discipline and paternal low involvement is associated with the disorder.

  18. Assessing the specificity of posttraumatic stress disorder's dysphoric items within the dysphoria model

    DEFF Research Database (Denmark)

    Armour, C.; Shevlin, M.

    2013-01-01

    The factor structure of posttraumatic stress disorder (PTSD) currently used by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), has received limited support. A four-factor dysphoria model is widely supported. However, the dysphoria factor of this model has been ...

  19. Work functioning in persons with depressive and anxiety disorders: The role of specific psychopathological characteristics

    NARCIS (Netherlands)

    Plaisier, I.; Beekman, A.T.F.; De Graaf, R.; Smit, J.H.; van Dyck, R.; Penninx, B.W.J.H.

    2010-01-01

    Background: Depressive and anxiety disorders affect work functioning and cause high labour costs. Aims: To examine and compare psychopathological characteristics of depressive and anxiety disorders in their effect on work functioning. Method: In 1876 working participants of the Netherlands Study of

  20. Sensitivity and Specificity of Proposed "DSM-5" Diagnostic Criteria for Autism Spectrum Disorder

    Science.gov (United States)

    McPartland, James C.; Reichow, Brian; Volkmar, Fred R.

    2012-01-01

    Objective: This study evaluated the potential impact of proposed "DSM-5" diagnostic criteria for autism spectrum disorder (ASD). Method: The study focused on a sample of 933 participants evaluated during the "DSM-IV" field trial; 657 carried a clinical diagnosis of an ASD, and 276 were diagnosed with a non-autistic disorder. Sensitivity and…

  1. 12 CFR 232.4 - Specific exceptions for obtaining and using medical information.

    Science.gov (United States)

    2010-01-01

    ... organization works through mortgage lenders and requires mortgage lenders to obtain medical information about... determines that it needs additional information regarding the consumer's circumstances, the creditor may... medical information. 232.4 Section 232.4 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD OF...

  2. The specification of a frame-based medical terminological system in Protégé

    NARCIS (Netherlands)

    Abu-Hanna, Ameen; Cornet, Ronald; de Keizer, Nicolette

    2004-01-01

    A medical terminological system (TS) is essentially a representation of concepts, attributes and relationships pertaining to medical terms. Although the requirements and structures of TSs have enjoyed some attention in the literature, the actual implementation of TSs consisted so far of ad-hoc

  3. Experiences of Students with Specific Learning Disorder (Including ADHD) in Online College Degree Programs: A Phenomenological Study

    Science.gov (United States)

    Bunch, Seleta LeAnn

    2016-01-01

    Enrollment in online degree programs is rapidly expanding due to the convenience and affordability offered to students and improvements in technology. The purpose of this hermeneutical phenomenological study was to understand the shared experiences of students with documented specific learning disorders (including Attention-Deficit/Hyperactivity…

  4. The reproducibility and responsiveness of a patient-specific approach: a new instrument in evaluation of treatment of temporomandibular disorders

    NARCIS (Netherlands)

    Rollman, A.; Naeije, M.; Visscher, C.M.

    2010-01-01

    AIMS: To evaluate the choice of activities on the Patient Specific Approach (PSA) in a sample of temporomandibular disorder (TMD) patients and to determine the clinimetric properties of the visual analog scale (VAS) scores of the PSA, in terms of reproducibility and responsiveness. METHODS: At

  5. The specificity of childhood adversities and negative life events across the life span to anxiety and depressive disorders

    NARCIS (Netherlands)

    Spinhoven, Philip; Elzinga, Bernet M.; Hovens, Jacqueline G. F. M.; Roelofs, Karin; Zitman, Frans G.; van Oppen, Patricia; Penninx, Brenda W. J. H.

    2010-01-01

    Background: Although several studies have shown that life adversities play an important role in the etiology and maintenance of both depressive and anxiety disorders, little is known about the relative specificity of several types of life adversities to different forms of depressive and anxiety

  6. Tract-Specific Analyses of Diffusion Tensor Imaging Show Widespread White Matter Compromise in Autism Spectrum Disorder

    Science.gov (United States)

    Shukla, Dinesh K.; Keehn, Brandon; Muller, Ralph-Axel

    2011-01-01

    Background: Previous diffusion tensor imaging (DTI) studies have shown white matter compromise in children and adults with autism spectrum disorder (ASD), which may relate to reduced connectivity and impaired function of distributed networks. However, tract-specific evidence remains limited in ASD. We applied tract-based spatial statistics (TBSS)…

  7. Higher Plasma Concentration of Food-Specific Antibodies in Persons with Autistic Disorder in Comparison to Their Siblings

    Science.gov (United States)

    Trajkovski, Vladimir; Petlichkovski, Aleksandar; Efinska-Mladenovska, Olivija; Trajkov, Dejan; Arsov, Todor; Strezova, Ana; Ajdinski, Ljubomir; Spiroski, Mirko

    2008-01-01

    Specific IgA, IgG, and IgE antibodies to food antigens in 35 participants with autistic disorder and 21 of their siblings in the Republic of Macedonia were examined. Statistically significant higher plasma concentration of IgA antibodies against alpha-lactalbumin, beta-lactoglobulin, casein, and gliadin were found in the children with autistic…

  8. Developmental Coordination Disorder in children with specific language impairment : Co-morbidity and impact on quality of life

    NARCIS (Netherlands)

    Flapper, Boudien C.T.; Schoemaker, Marina M.

    Co-morbidity of Developmental Coordination Disorder (DCD) in children with specific language impairment (SLI) and the impact of DCD on quality-of-life (QOL) was investigated in 65 5-8 year old children with SLI (43 boys, age 6.8 +/- 0.8; 22 girls, age 6.6 +/- 0.8). The prevalence of DCD was assessed

  9. The specific and combined role of domestic violence and mental health disorders during pregnancy on new-born health.

    Science.gov (United States)

    Ferraro, Alexandre Archanjo; Rohde, Luis Augusto; Polanczyk, Guilherme Vanoni; Argeu, Adriana; Miguel, Euripides Constantino; Grisi, Sandra Josefina Ferraz Ellero; Fleitlich-Bilyk, Bacy

    2017-08-01

    Addressing impaired foetal growth is recognized as a public health priority. Certain risk factors for this condition, such as poor nutritional status at birth, have been found to be highly correlated with poverty. However, the role of psychosocial factors, specifically the mother's mental health and exposure to violence during pregnancy, have yet to be further explored. Our objective was to determine if there is a measurable association between combined psychosocial factors, specifically domestic violence and mental disorders, and birth outcomes, specifically birth nutritional status and preterm delivery. We followed 775 women from an underserved, urban area, beginning their 28th week of gestation. Diagnostic interviews were performed to determine if any of the mothers had any of the following disorders: mood disorder, anxiety, obsessive-compulsive disorder (OCD), substance dependence, psychotic disorder, or anti-social personality disorder. Physical, psychological, and sexual domestic violence were also assessed. Domestic violence and mental disorders were highly correlated in our sample. About 27.15% of the women in our study experienced domestic violence, and about 38.24% of them were diagnosed with mental disorders. The main association we found between combined psychosocial factors and neonate outcomes was between anxiety (IRR = 1.83; 95%CI = 1.06-3.17)/physical violence (IRR = 1.95; 95%CI = 1.11-3.42) and the rate of small-for-gestational age (SGA) in new-borns. More specifically, the combination of anxiety (beta = -0.48; 95%CI = -0.85/-0.10) and sexual violence (beta = -1.58; 95%CI = -2.61/-0.54) was also associated with birth length. Maternal risk behaviours such as smoking, drinking, inadequate prenatal care, and inadequate weight gain could not sufficiently explain these associations, suggesting that these psychosocial factors may be influencing underlying biological mechanisms. Domestic violence against women and mental disorders amongst

  10. Impact of one-dose package dispensing with patient counseling on medication adherence in geriatrics suffering from chronic disorders

    Directory of Open Access Journals (Sweden)

    Narayana Goruntla

    2018-01-01

    Full Text Available Introduction: Medication nonadherence in elderly patients could result in a waste of medical expenses in a long-time span as well as deterioration of the patient's medical condition. Aim: The aim of this study is to evaluate the impact of one-dose package dispensing with patient counseling on medication adherence among elderly patients suffering from chronic disorders. Settings and Design: This is prospective, open-labeled, randomized trial carried out at dispensing pharmacy of the secondary care referral hospital, located in resource-limited settings of Anantapur District, Andhra Pradesh, India. Subjects and Methods: A total of 330 (aged ≥60 years patients were randomly assigned to one of three study groups: Group A (n = 110, no change in dosing and packing; Group B (n = 110, one-dose package dispensing; Group C (n = 110, One-dose package dispensing with patient counseling. Medication adherence levels were measured using a pill count and visual analog scale (VAS method at baseline and follow-up (after 1 month. Statistical Analysis: Descriptive statistics were used to represent the sociodemographic, clinical, and medication adherence profile of study participants. One-way ANOVA test is used to assess significant differences between three groups with a P 60 years who are on multiple medications can benefit from one-dose package dispensing and appropriate counseling. This will improve medication adherence hence better outcomes.

  11. The transition to medication adoption in publicly funded substance use disorder treatment programs: organizational structure, culture, and resources.

    Science.gov (United States)

    Knudsen, Hannah K; Roman, Paul M

    2014-05-01

    Medications for the treatment of substance use disorders (SUDs) are not widely available in publicly funded SUD treatment programs. Few studies have drawn on longitudinal data to examine the organizational characteristics associated with programs transitioning from not delivering any pharmacotherapy to adopting at least one SUD medication. Using two waves of panel longitudinal data collected over a 5-year period, we measured the transition to medication adoption in a cohort of 190 publicly funded treatment organizations that offered no SUD medications at baseline. Independent variables included organizational characteristics, medical resources, funding, treatment culture, and detailing activities by pharmaceutical companies. Of 190 programs not offering SUD pharmacotherapy at baseline, 22.6% transitioned to offering at least one SUD medication at follow-up approximately 5 years later. Multivariate logistic regression results indicated that the employment of at least one physician at baseline, having a greater proportion of Medicaid clients, and pharmaceutical detailing were positively associated with medication adoption. Adoption of pharmacotherapy was more likely in programs that had greater medical resources, Medicaid funding, and contact with pharmaceutical companies. Given the potential expansion of Medicaid under the Affordable Care Act, patients served by publicly funded programs may gain greater access to such treatments, but research is needed to document health reform's impact on this sector of the treatment system.

  12. Investigation of Factors Affecting Musculoskeletal Disorders among Hospital Emergency Nurses of Qom University of Medical Sciences, Iran

    Directory of Open Access Journals (Sweden)

    Mohsen Farahabadi

    2016-11-01

    Full Text Available Abstract Background and Objectives: Musculoskeletal disorders are one of the most common and costly occupational injuries, because they account for one-third of work-related injuries per year. In this study, the factors affecting musculoskeletal disorders, were investigated among hospital emergency nurses of Qom University of Medical Sciences. Methods: This study was performed as a descriptive cross-sectional study using census method on 127 nurses in the Emergency Department of hospitals affiliated to Qom University of Medical Sciences in 2014. The participants completed the Nordic musculoskeletal disorders questionnaire. Data analysis was carried out using Mann-Whitney and the Chi-square Statistical tests. The significance level was considered to be 0.05. Results: In this study, 46 (36.2% participants were men and the remaining were women. The mean age was 33.87±8.892 and the mean work hours per week was 57.71±17.675. The overall prevalence of musculoskeletal disorder was reported to be 82.7%, which had significant relationships with weight, interference with daily work, and pain per day (p0.05. Also, only 16 subjects had participated in ergonomics workshops and 118 subjects were aware of the occupational risks. Conclusion: According to the results of this study and high prevalence of musculoskeletal disorders among nurses, it is suggested that given the type of disorder, change in the way of job performance, adjustment of working hours, holding ergonomics workshops, and preventive measures be placed on the agenda. Keywords: Musculoskeletal disorder; Emergency nurses; Occupational injuries.

  13. Assessing medication adherence and healthcare utilization and cost patterns among hospital-discharged patients with schizoaffective disorder.

    Science.gov (United States)

    Karve, Sudeep; Markowitz, Michael; Fu, Dong-Jing; Lindenmayer, Jean-Pierre; Wang, Chi-Chuan; Candrilli, Sean D; Alphs, Larry

    2014-06-01

    Hospital-discharged patients with schizoaffective disorder have a high risk of re-hospitalization. However, limited data exist evaluating critical post-discharge periods during which the risk of re-hospitalization is significant. Among hospital-discharged patients with schizoaffective disorder, we assessed pharmacotherapy adherence and healthcare utilization and costs during sequential 60-day clinical periods before schizoaffective disorder-related hospitalization and post-hospital discharge. From the MarketScan(®) Medicaid database (2004-2008), we identified patients (≥18 years) with a schizoaffective disorder-related inpatient admission. Study measures including medication adherence and healthcare utilization and costs were assessed during sequential preadmission and post-discharge periods. We conducted univariate and multivariable regression analyses to compare schizoaffective disorder-related and all-cause healthcare utilization and costs (in 2010 US dollars) between each adjacent 60-day post-discharge periods. No adjustment was made for multiplicity. We identified 1,193 hospital-discharged patients with a mean age of 41 years. The mean medication adherence rate was 46% during the 60-day period prior to index inpatient admission, which improved to 80% during the 60-day post-discharge period. Following hospital discharge, schizoaffective disorder-related healthcare costs were significantly greater during the initial 60-day period compared with the 61- to 120-day post-discharge period (mean US$2,370 vs US$1,765; p schizoaffective disorder-related costs declined during the 61- to 120-day post-discharge period and remained stable for the remaining post-discharge periods (days 121-365). We observed considerably lower (46%) adherence during 60 days prior to the inpatient admission; in comparison, adherence for the overall 6-month period was 8% (54%) higher. Our study findings suggest that both short-term (e.g., 60 days) and long-term (e.g., 6-12 months) medication

  14. Cognitive Risk Factors for Specific Learning Disorder: Processing Speed, Temporal Processing, and Working Memory.

    Science.gov (United States)

    Moll, Kristina; Göbel, Silke M; Gooch, Debbie; Landerl, Karin; Snowling, Margaret J

    2016-01-01

    High comorbidity rates between reading disorder (RD) and mathematics disorder (MD) indicate that, although the cognitive core deficits underlying these disorders are distinct, additional domain-general risk factors might be shared between the disorders. Three domain-general cognitive abilities were investigated in children with RD and MD: processing speed, temporal processing, and working memory. Since attention problems frequently co-occur with learning disorders, the study examined whether these three factors, which are known to be associated with attention problems, account for the comorbidity between these disorders. The sample comprised 99 primary school children in four groups: children with RD, children with MD, children with both disorders (RD+MD), and typically developing children (TD controls). Measures of processing speed, temporal processing, and memory were analyzed in a series of ANCOVAs including attention ratings as covariate. All three risk factors were associated with poor attention. After controlling for attention, associations with RD and MD differed: Although deficits in verbal memory were associated with both RD and MD, reduced processing speed was related to RD, but not MD; and the association with RD was restricted to processing speed for familiar nameable symbols. In contrast, impairments in temporal processing and visuospatial memory were associated with MD, but not RD. © Hammill Institute on Disabilities 2014.

  15. Overlapping and disease specific aspects of impulsivity in children and adolescents with schizophrenia spectrum disorders or Attention-Deficit/Hyperactivity Disorder

    DEFF Research Database (Denmark)

    Jepsen, Jens Richardt Møllegaard; Rydkjær, Jacob; Fagerlund, Birgitte

    Objectives: To identify disease specific and overlapping aspects of impulsivity in children and adolescents with early-onset schizophrenia spectrum disorders or ADHD. Methods: Motor impulsivity (Stop Signal Task), reflection impulsivity (Information Sampling Task), and trait impulsivity (Barratt ...... their decision making to gather more information in a condition with a conflict between reward and certainty. The reduced information sampling may also reflect an increased conviction in the decision at a point of relative uncertainty....

  16. Disorder-specific characteristics of borderline personality disorder with co-occurring depression and its comparison with major depression: An fMRI study with emotional interference task

    Directory of Open Access Journals (Sweden)

    Natalia Chechko

    2016-01-01

    Thus, our data indicate dysfunctionality in the neural circuitry responsible for emotional conflict control in both disorders. The enhanced visual cortex activation in BPD + MDD suggests the visual system's hyperresponsiveness to faces at an early perceptual level. Not being associated with co-occurring depression, this effect in BPD + MDD appears to represent specific personality traits such as disturbed reactivity toward emotionally expressive facial stimuli.

  17. A new computerized cognitive and social cognition training specifically designed for patients with schizophrenia/schizoaffective disorder in early stages of illness: A pilot study.

    Science.gov (United States)

    Fernandez-Gonzalo, Sol; Turon, Marc; Jodar, Merce; Pousa, Esther; Hernandez Rambla, Carla; García, Rebeca; Palao, Diego

    2015-08-30

    People with schizophrenia/schizoaffective disorders at early stages of the illness present cognitive and social cognition deficits that have a great impact in functional outcomes. Cognitive Remediation Therapy (CRT) has demonstrated consistent effect in cognitive performance, symptoms and psychosocial functioning. However, any CRT intervention or social cognition training have been specifically designed for patients in the early stages of psychosis. The aim of this pilot study is to assess the efficacy of a new computerized cognitive and social cognition program for patients with schizophrenia/schizoaffective disorder with recent diagnosis. A comprehensive assessment of clinical, social and non-social cognitive and functional measures was carried out in 53 randomized participants before and after the 4-months treatment. Significant results were observed in Spatial Span Forwards, Immediate Logical Memory and Pictures of Facial Affect (POFA) total score. None of these results were explained by medication, premorbid social functioning or psychopathological symptoms. No impact of the intervention was observed in other cognitive and social cognition outcome neither in clinical and functional outcomes. This new computerized intervention may result effective ameliorating visual attention, logical memory and emotional processing in patients in the early stages of schizophrenia/schizoaffective disorder. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  18. Post hoc analysis of plasma amino acid profiles: towards a specific pattern in autism spectrum disorder and intellectual disability.

    Science.gov (United States)

    Delaye, Jean-Baptiste; Patin, Franck; Lagrue, Emmanuelle; Le Tilly, Olivier; Bruno, Clement; Vuillaume, Marie-Laure; Raynaud, Martine; Benz-De Bretagne, Isabelle; Laumonnier, Frederic; Vourc'h, Patrick; Andres, Christian; Blasco, Helene

    2018-01-01

    Objectives Autism spectrum disorders and intellectual disability present a challenge for therapeutic and dietary management. We performed a re-analysis of plasma amino acid chromatography of children with autism spectrum disorders ( n = 22) or intellectual disability ( n = 29) to search for a metabolic signature that can distinguish individuals with these disorders from controls ( n = 30). Methods We performed univariate and multivariate analyses using different machine learning strategies, from the raw data of the amino acid chromatography. Finally, we analysed the metabolic pathways associated with discriminant biomarkers. Results Multivariate analysis revealed models to discriminate patients with autism spectrum disorders or intellectual disability and controls from plasma amino acid profiles ( P intellectual disability patients shared similar differences relative to controls, including lower glutamate ( P intellectual disability revealed the involvement of urea, 3-methyl-histidine and histidine metabolism. Biosigner analysis and univariate analysis confirmed the role of 3-methylhistidine ( P = 0.004), histidine ( P = 0.003), urea ( P = 0.0006) and lysine ( P = 0.002). Conclusions We revealed discriminant metabolic patterns between autism spectrum disorders, intellectual disability and controls. Amino acids known to play a role in neurotransmission were discriminant in the models comparing autism spectrum disorders or intellectual disability to controls, and histidine and b-alanine metabolism was specifically highlighted in the model.

  19. Prevalence of common mental disorders among Dutch medical students and related use and need of mental health care: a cross-sectional study

    NARCIS (Netherlands)

    Gaspersz, Roxanne; Frings-Dresen, Monique H. W.; Sluiter, Judith K.

    2012-01-01

    The purpose of the study was to assess common mental disorders and the related use and need for mental health care among clinically not yet active and clinically active medical students. All medical students (n=2266) at one Dutch medical university were approached. Students from study years 1-4 were

  20. The review of most frequently occurring medical disorders related to aetiology of autism and the methods of treatment.

    Science.gov (United States)

    Cubala-Kucharska, Magdalena

    2010-01-01

    The medical understanding of autism has changed since it was first defined by Kanner. Nowadays medicine identifies many medical abnormalities and diseases, which may underline or aggravate the cognitive aspect, behavioural issues and general health in autists. This includes chronic inflammation of gastrointestinal tract, dysbiosis, maldigestion, malabsorption, malnutrition, food intolerance, allergies, chronic viral, fungal and bacterial infections, impaired kidney function, impaired detoxification of endo- and exotoxins, disorders of metal ion transportation. Treatment of the above mentioned conditions combined with improving detoxification mechanisms, followed by a special diet and individually customized supplementation of nutritional deficiencies may lead to the improvement of the functioning of these patients, changing their level of functioning and self-dependence. The aim of this paper is to present medical problems of children with autism which may be identified and treated by general practitioners as a review of current medical papers related to Autism Spectrum Disorder, in the context of author's professional experience, based on the medical cases from author's practice.

  1. Loose regulation of medical marijuana programs associated with higher rates of adult marijuana use but not cannabis use disorder.

    Science.gov (United States)

    Williams, Arthur Robin; Santaella-Tenorio, Julian; Mauro, Christine M; Levin, Frances R; Martins, Silvia S

    2017-11-01

    Most US states have passed medical marijuana laws (MMLs), with great variation in program regulation impacting enrollment rates. We aimed to compare changes in rates of marijuana use, heavy use and cannabis use disorder across age groups while accounting for whether states enacted medicalized (highly regulated) or non-medical mml programs. Difference-in-differences estimates with time-varying state-level MML coded by program type (medicalized versus non-medical). Multi-level linear regression models adjusted for state-level random effects and covariates as well as historical trends in use. Nation-wide cross-sectional survey data from the US National Survey of Drug Use and Health (NSDUH) restricted use data portal aggregated at the state level. Participants comprised 2004-13 NSDUH respondents (n ~ 67 500/year); age groups 12-17, 18-25 and 26+ years. States had implemented eight medicalized and 15 non-medical MML programs. Primary outcome measures included (1) active (past-month) marijuana use; (2) heavy use (> 300 days/year); and (3) cannabis use disorder diagnosis, based on DSM-IV criteria. Covariates included program type, age group and state-level characteristics throughout the study period. Adults 26+ years of age living in states with non-medical MML programs increased past-month marijuana use 1.46% (from 4.13 to 6.59%, P = 0.01), skewing towards greater heavy marijuana by 2.36% (from 14.94 to 17.30, P = 0.09) after MMLs were enacted. However, no associated increase in the prevalence of cannabis use disorder was found during the study period. Our findings do not show increases in prevalence of marijuana use among adults in states with medicalized MML programs. Additionally, there were no increases in adolescent or young adult marijuana outcomes following MML passage, irrespective of program type. Non-medical marijuana laws enacted in US states are associated with increased marijuana use, but only among adults aged 26+ years. Researchers and

  2. Scientific profile and professional responsibility of Court-appointed Medical Technical Consultants in Italy: time for a specific educational curriculum?

    Science.gov (United States)

    Conti, Andrea Alberto

    2014-08-20

    Court-appointed Technical Consultants (CTCs) are fundamental figures in the Italian judicial system. CTCs are experts appointed by judges in order to supplement their activities by ascertaining, collecting and analyzing facts concerning the specific subject of a lawsuit. These experts formulate opinions, gather motivations and perform checks to provide clear, objective and irrefutable answers to the questions posed by judges. With direct reference to the medical field, while police doctors (specialists in forensic medicine) follow an academic, dedicated, well-structured educational curriculum, the University specialty school in Forensic Medicine, other medical CTCs, though not infrequently luminaries with one or many medical specialties and professional acknowledgments, may have no specific legal-medicine and juridical expertise, precisely because a similar expertise is not formally required of them. In the light of these considerations, in Italy some professionals of the legal world, and of the health context too, have proposed for medical CTCs targeted educational pathways, which would provide these experts with formal specific qualifications. In synthesis and in conclusion, a full knowledge and a rigorous respect of the rules of legal proceedings emerge as increasingly important characteristics for current and future Court-appointed Technical Consultants, together with a specific educational curriculum.

  3. 21 CFR 862.2050 - General purpose laboratory equipment labeled or promoted for a specific medical use.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false General purpose laboratory equipment labeled or... TOXICOLOGY DEVICES Clinical Laboratory Instruments § 862.2050 General purpose laboratory equipment labeled or promoted for a specific medical use. (a) Identification. General purpose laboratory equipment labeled or...

  4. Testing tic suppression: comparing the effects of dexmethylphenidate to no medication in children and adolescents with attention-deficit/hyperactivity disorder and Tourette's disorder.

    Science.gov (United States)

    Lyon, Gholson J; Samar, Stephanie M; Conelea, Christine; Trujillo, Marcel R; Lipinski, Christina M; Bauer, Christopher C; Brandt, Bryan C; Kemp, Joshua J; Lawrence, Zoe E; Howard, Jonathan; Castellanos, F Xavier; Woods, Douglas; Coffey, Barbara J

    2010-08-01

    The aim of this study was to conduct a pilot study testing whether single-dose, immediate-release dexmethylphenidate (dMPH) can facilitate tic suppression in children and adolescents with attention-deficit/hyperactivity disorder (ADHD) and Tourette's disorder (TD) or chronic tic disorders. The primary hypothesis is that dMPH will improve behaviorally reinforced tic suppression in a standard tic suppression paradigm (TSP). Ten children with ADHD and TD were given dMPH on one visit and no medication on another, using a random crossover design. On both days, following a baseline period, subjects were reinforced for suppressing tics using a standard TSP. Thirteen subjects were enrolled; 10 subjects (mean age 12.7 +/- 2.6; 90% male) completed all study procedures. Relative to the no-medication condition, tics were reduced when children were given a single dose of dMPH. Behavioral reinforcement of tic suppression resulted in lower rates of tics compared to baseline, but dMPH did not enhance this suppression. Preliminary results indicate replication of prior studies of behavioral tic suppression in youths with TD and without ADHD. In addition, our findings indicate tic reduction (and not tic exacerbation) with acute dMPH challenge in children and adolescents with ADHD and TD.

  5. Brain structural anomalies in borderline and avoidant personality disorder patients and their associations with disorder-specific symptoms.

    Science.gov (United States)

    Denny, Bryan T; Fan, Jin; Liu, Xun; Guerreri, Stephanie; Mayson, Sarah Jo; Rimsky, Liza; McMaster, Antonia; Alexander, Heather; New, Antonia S; Goodman, Marianne; Perez-Rodriguez, Mercedes; Siever, Larry J; Koenigsberg, Harold W

    2016-08-01

    Borderline personality disorder (BPD) and avoidant personality disorder (AvPD) are characterized by hyper-reactivity to negatively-perceived interpersonal cues, yet they differ in degree of affective instability. Recent work has begun to elucidate the neural (structural and functional) and cognitive-behavioral underpinnings of BPD, although some initial studies of brain structure have reached divergent conclusions. AvPD, however, has been almost unexamined in the cognitive neuroscience literature. In the present study we investigated group differences among 29 BPD patients, 27 AvPD patients, and 29 healthy controls (HC) in structural brain volumes using voxel-based morphometry (VBM) in five anatomically-defined regions of interest: amygdala, hippocampus, medial prefrontal cortex (MPFC), dorsolateral prefrontal cortex (DLPFC), and anterior cingulate cortex (ACC). We also examined the relationship between individual differences in brain structure and self-reported anxiety and affective instability in each group. We observed reductions in MPFC and ACC volume in BPD relative to HC, with no significant difference among patient groups. No group differences in amygdala volume were found. However, BPD and AvPD patients each showed a positive relationship between right amygdala volume and state-related anxiety. By contrast, in HC there was an inverse relationship between MPFC volume and state and trait-related anxiety as well as between bilateral DLPFC volume and affective instability. Current sample sizes did not permit examination of gender effects upon structure-symptom correlations. These results shed light on potentially protective, or compensatory, aspects of brain structure in these populations-namely, relatively reduced amygdala volume or relatively enhanced MPFC and DLPFC volume. Published by Elsevier B.V.

  6. Online-specific fear of missing out and Internet-use expectancies contribute to symptoms of Internet-communication disorder.

    Science.gov (United States)

    Wegmann, Elisa; Oberst, Ursula; Stodt, Benjamin; Brand, Matthias

    2017-06-01

    Some of the most frequently used online applications are Facebook, WhatsApp, and Twitter. These applications allow individuals to communicate with other users, to share information or pictures, and to stay in contact with friends all over the world. However, a growing number of users suffer from negative consequences due to their excessive use of these applications, which can be referred to as Internet-communication disorder. The frequent use and easy access of these applications may also trigger the individual's fear of missing out on content when not accessing these applications. Using a sample of 270 participants, a structural equation model was analyzed to investigate the role of psychopathological symptoms and the fear of missing out on expectancies towards Internet-communication applications in the development of symptoms of an Internet-communication disorder. The results suggest that psychopathological symptoms predict higher fear of missing out on the individual's Internet-communication applications and higher expectancies to use these applications as a helpful tool to escape from negative feelings. These specific cognitions mediate the effect of psychopathological symptoms on Internet-communication disorder. Our results are in line with the theoretical model by Brand et al. (2016) as they show how Internet-related cognitive bias mediates the relationship between a person's core characteristics (e.g., psychopathological symptoms) and Internet-communication disorder. However, further studies should investigate the role of the fear of missing out as a specific predisposition, as well as specific cognition in the online context.

  7. Online-specific fear of missing out and Internet-use expectancies contribute to symptoms of Internet-communication disorder

    Directory of Open Access Journals (Sweden)

    Elisa Wegmann

    2017-06-01

    Full Text Available Some of the most frequently used online applications are Facebook, WhatsApp, and Twitter. These applications allow individuals to communicate with other users, to share information or pictures, and to stay in contact with friends all over the world. However, a growing number of users suffer from negative consequences due to their excessive use of these applications, which can be referred to as Internet-communication disorder. The frequent use and easy access of these applications may also trigger the individual's fear of missing out on content when not accessing these applications. Using a sample of 270 participants, a structural equation model was analyzed to investigate the role of psychopathological symptoms and the fear of missing out on expectancies towards Internet-communication applications in the development of symptoms of an Internet-communication disorder. The results suggest that psychopathological symptoms predict higher fear of missing out on the individual's Internet-communication applications and higher expectancies to use these applications as a helpful tool to escape from negative feelings. These specific cognitions mediate the effect of psychopathological symptoms on Internet-communication disorder. Our results are in line with the theoretical model by Brand et al. (2016 as they show how Internet-related cognitive bias mediates the relationship between a person's core characteristics (e.g., psychopathological symptoms and Internet-communication disorder. However, further studies should investigate the role of the fear of missing out as a specific predisposition, as well as specific cognition in the online context.

  8. [Impact of education program and clinical posting in psychiatry on medical students' stigmatizing attitudes towards psychiatry and psychiatric disorders].

    Science.gov (United States)

    Simon, N; Verdoux, H

    2017-06-09

    The aim of the study was to explore whether a medical student education program and clinical posting in psychiatry had an impact on medical students' stigmatizing attitudes towards psychiatry and psychiatric disorders. Medical students from the University of Bordeaux were recruited during their 4-year course at the beginning of the academic education program in psychiatry. Medical students who were concomitantly in a clinical posting in wards of psychiatry or neurology were invited to participate in the study. The medical student version of the scale Mental Illness: Clinicians' Attitudes (MICA) was used to measure their attitudes towards psychiatry and persons with psychiatric disorder. This 16-item scale is designed to measure attitudes of health care professionals towards people with mental illness, a higher score indicating more stigmatizing attitudes. Items exploring history of psychiatric disorders in close persons were added at the end of the MICA scale. The questionnaire was completed twice by each student, at the beginning and the end of the 11-week clinical posting. All questionnaires were strictly anonymized. Multivariate linear regression analyses were used to identify the variables independently associated with MICA total score. At the beginning of the education program and clinical posting, 174 students completed the MICA scale: the mean MICA total score was equal to 46.4 (SD 6.9) in students in clinical posting in psychiatry (n=72) and 45.1 (SD 7.01) in those in neurology (n=102). At the end of the academic and clinical training, 138 students again completed the questionnaire, with mean MICA total scores equal to 41.4 (SD 8.1) in students in clinical posting in psychiatry (n=51) and 43.5 (SD 7.3) in those in neurology (n=87). Multivariate analyses showed that lower total MICA scores were independently associated with the time of assessment (lower scores at the end of education program and clinical posting) (b=-2.8; P=0.001), female gender (b=-1.8; P=0

  9. Gender confirming medical interventions and eating disorder symptoms among transgender individuals.

    Science.gov (United States)

    Testa, Rylan J; Rider, G Nicole; Haug, Nancy A; Balsam, Kimberly F

    2017-10-01

    Studies indicate that transgender individuals may be at risk of developing eating disorder symptoms (EDS). Elevated risk may be attributed to body dissatisfaction and/or societal reactions to nonconforming gender expression, such as nonaffirmation of a person's gender identity (e.g., using incorrect pronouns). Limited research suggests that gender-confirming medical interventions (GCMIs) may prevent or reduce EDS among transgender people. Participants included 154 transfeminine spectrum (TFS) and 288 transmasculine spectrum (TMS) individuals who completed the Trans Health Survey. Serial multiple mediation analyses controlling for age, education, and income were used to examine whether body satisfaction and nonaffirmation mediate any found relationships between various GCMIs (genital surgery, chest surgery, hormone use, hysterectomy, and hair removal) and EDS. For TFS individuals, the nonaffirmation to body satisfaction path mediated relationships between all GCMIs and EDS, although body satisfaction alone accounted for more of the indirect effects than this path for chest surgery. For TMS individuals, relationships between all GCMIs and EDS were mediated by the nonaffirmation to body satisfaction path. Findings support the hypothesis that GCMIs reduce experiences of nonaffirmation, which increases body satisfaction and thus decreases EDS. Among TFS participants, the relationship between chest surgery and lower levels of EDS was mediated most strongly by body satisfaction alone, suggesting that satisfaction with one's body may result in lower EDS even if affirmation from the external world is unchanged. Implications of these findings for intervention, policy, and legal efforts are discussed, and future research recommendations are provided. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  10. The use of medication against attention deficit/hyperactivity disorder in Denmark: a drug use study from a national perspective

    DEFF Research Database (Denmark)

    Pottegård, Anton; Bjerregaard, Bine Kjøller; Glintborg, Dorte

    2012-01-01

    Purpose The purpose of the study was to characterize the utilization of medication against attention deficit hyperactivity disorder (ADHD) in Denmark between 1995 and 2011 from a national perspective, by using population-based prescription data. Methods National data on drug use in Denmark between...... and lacking evidence of heavy users. However, the prescriber profile for incident users and the large regional variances raise concerns. It is therefore vital that the use of ADHD drugs is closely monitored....

  11. Overlapping and disease specific trait, response, and reflection impulsivity in adolescents with first-episode schizophrenia spectrum disorders or attention-deficit/hyperactivity disorder.

    Science.gov (United States)

    Jepsen, J R M; Rydkjaer, J; Fagerlund, B; Pagsberg, A K; Jespersen, R Av F; Glenthøj, B Y; Oranje, B

    2018-03-01

    Schizophrenia and attention-deficit/hyperactivity disorder (ADHD) are developmental disorders with shared clinical characteristics such as cognitive impairments and impulsivity. Impulsivity is a core feature of ADHD and an important factor in aggression, violence, and substance use in schizophrenia. Based on the hypothesis that schizophrenia and ADHD represent a continuum of neurodevelopmental impairments, the aim was to identify overlapping and disease specific forms of impulsivity. Adolescents between 12 and 17 years of age were assessed with the Schedule for Affective Disorders and Schizophrenia for School-aged Children - Present and Lifetime Version. Subjects with early-onset, first-episode schizophrenia spectrum disorders (EOS) (N = 29) or ADHD (N = 29) and healthy controls (N = 45) were compared on two performance measures (Information Sampling Task, Stop Signal Task) and a subjective personality trait measure of impulsivity (Barratt Impulsiveness Scale, Version 11 (BIS-11)). Significantly increased reflection impulsivity was observed in ADHD but not in the EOS group. No significant response inhibition deficits (stop signal reaction time) were found in the two clinical groups. The ADHD and the EOS group showed significantly increased motor, attentional, and non-planning subtraits of impulsivity. Impaired pre-decisional information gathering appeared to be specific for ADHD while the information gathering was not significantly reduced in subjects with EOS. Neither the ADHD nor EOS group showed impaired response inhibition but shared increased personality subtraits of attentional, non-planning, and motor impulsivity although the latter was significantly more pronounced in ADHD. These increased subtraits of impulsivity may reflect diagnostic non-specific neurodevelopmental impairments in ADHD and EOS in adolescence.

  12. Temporal, Diagnostic, and Tissue-Specific Regulation of NRG3 Isoform Expression in Human Brain Development and Affective Disorders

    Science.gov (United States)

    Paterson, Clare; Wang, Yanhong; Hyde, Thomas M.; Weinberger, Daniel R.; Kleinman, Joel E.; Law, Amanda J.

    2018-01-01

    Objective Genes implicated in schizophrenia are enriched in networks differentially regulated during human CNS development. Neuregulin 3 (NRG3), a brain-enriched neurotrophin, undergoes alternative splicing and is implicated in several neurological disorders with developmental origins. Isoform-specific increases in NRG3 are observed in schizophrenia and associated with rs10748842, a NRG3 risk polymorphism, suggesting NRG3 transcriptional dysregulation as a molecular mechanism of risk. The authors quantitatively mapped the temporal trajectories of NRG3 isoforms (classes I–IV) in the neocortex throughout the human lifespan, examined whether tissue-specific regulation of NRG3 occurs in humans, and determined if abnormalities in NRG3 transcriptomics occur in mood disorders and are genetically determined. Method NRG3 isoform classes I–IV were quantified using quantitative real-time polymerase chain reaction in human postmortem dorsolateral prefrontal cortex from 286 nonpsychiatric control individuals, from gestational week 14 to 85 years old, and individuals diagnosed with either bipolar disorder (N=34) or major depressive disorder (N=69). Tissue-specific mapping was investigated in several human tissues. rs10748842 was genotyped in individuals with mood disorders, and association with NRG3 isoform expression examined. Results NRG3 classes displayed individually specific expression trajectories across human neocortical development and aging; classes I, II, and IV were significantly associated with developmental stage. NRG3 class I was increased in bipolar and major depressive disorder, consistent with observations in schizophrenia. NRG3 class II was increased in bipolar disorder, and class III was increased in major depression. The rs10748842 risk genotype predicted elevated class II and III expression, consistent with previous reports in the brain, with tissue-specific analyses suggesting that classes II and III are brain-specific isoforms of NRG3. Conclusions

  13. The Quality of Medication Treatment for Mental Disorders in the Department of Veterans Affairs and in Private-Sector Plans.

    Science.gov (United States)

    Watkins, Katherine E; Smith, Brad; Akincigil, Ayse; Sorbero, Melony E; Paddock, Susan; Woodroffe, Abigail; Huang, Cecilia; Crystal, Stephen; Pincus, Harold Alan

    2016-04-01

    The quality of mental health care provided by the U.S. Department of Veterans Affairs (VA) was compared with care provided to a comparable population treated in the private sector. Two cohorts of individuals with mental disorders (schizophrenia, bipolar disorder, posttraumatic stress disorder, major depression, and substance use disorders) were created with VA administrative data (N=836,519) and MarketScan data (N=545,484). The authors computed VA and MarketScan national means for seven process-based quality measures related to medication evaluation and management and estimated national-level performance by age and gender. In every case, VA performance was superior to that of the private sector by more than 30%. Compared with individuals in private plans, veterans with schizophrenia or major depression were more than twice as likely to receive appropriate initial medication treatment, and veterans with depression were more than twice as likely to receive appropriate long-term treatment. Findings demonstrate the significant advantages that accrue from an organized, nationwide system of care. The much higher performance of the VA has important clinical and policy implications.

  14. Does a PBL-based medical curriculum predispose training in specific career paths? A systematic review of the literature.

    Science.gov (United States)

    Tsigarides, Jordan; Wingfield, Laura R; Kulendran, Myutan

    2017-01-07

    North American medical schools have used problem-based learning (PBL) structured medical education for more than 60 years. However, it has only recently been introduced in other medical schools outside of North America. Since its inception, there has been the debate on whether the PBL learning process predisposes students to select certain career paths. To review available evidence to determine the predisposition of specific career paths when undertaking a PBL-based medical curriculum. The career path trajectory was determined as measured by official Matching Programs, self-reported questionnaires and surveys, and formally defined career development milestones. A systematic literature review was performed. PubMed, Medline, Cochrane and ERIC databases were analysed in addition to reference lists for appropriate inclusion. Eleven studies fitting the inclusion criteria were identified. The majority of studies showed that PBL did not predispose a student to a career in a specific speciality (n = 7 out of 11 studies, 64%). However, three studies reported a significantly increased number of PBL graduates working in primary care compared to those from a non-PBL curriculum. PBL has been shown not to predispose medical students to a career in General Practice or any other speciality. Furthermore, a greater number of similar studies are required before a definitive conclusion can be made in the future.

  15. Using selected scenes from Brazilian films to teach about substance use disorders, within medical education

    Directory of Open Access Journals (Sweden)

    João Mauricio Castaldelli-Maia

    Full Text Available CONTEXT AND OBJECTIVES: Themes like alcohol and drug abuse, relationship difficulties, psychoses, autism and personality dissociation disorders have been widely used in films. Psychiatry and psychiatric conditions in various cultural settings are increasingly taught using films. Many articles on cinema and psychiatry have been published but none have presented any methodology on how to select material. Here, the authors look at the portrayal of abusive use of alcohol and drugs during the Brazilian cinema revival period (1994 to 2008. DESIGN AND SETTING: Qualitative study at two universities in the state of São Paulo. METHODS: Scenes were selected from films available at rental stores and were analyzed using a specifically designed protocol. We assessed how realistic these scenes were and their applicability for teaching. One author selected 70 scenes from 50 films (graded for realism and teaching applicability > 8. These were then rated by another two judges. Rating differences among the three judges were assessed using nonparametric tests (P 8 were defined as "quality scenes". RESULTS: Thirty-nine scenes from 27 films were identified as "quality scenes". Alcohol, cannabis, cocaine, hallucinogens and inhalants were included in these. Signs and symptoms of intoxication, abusive/harmful use and dependence were shown. CONCLUSIONS: We have produced rich teaching material for discussing psychopathology relating to alcohol and drug use that can be used both at undergraduate and at postgraduate level. Moreover, it could be seen that certain drug use behavioral patterns are deeply rooted in some Brazilian films and groups.

  16. Using selected scenes from Brazilian films to teach about substance use disorders, within medical education.

    Science.gov (United States)

    Castaldelli-Maia, João Mauricio; Oliveira, Hercílio Pereira; Andrade, Arthur Guerra; Lotufo-Neto, Francisco; Bhugra, Dinesh

    2012-01-01

    Themes like alcohol and drug abuse, relationship difficulties, psychoses, autism and personality dissociation disorders have been widely used in films. Psychiatry and psychiatric conditions in various cultural settings are increasingly taught using films. Many articles on cinema and psychiatry have been published but none have presented any methodology on how to select material. Here, the authors look at the portrayal of abusive use of alcohol and drugs during the Brazilian cinema revival period (1994 to 2008). Qualitative study at two universities in the state of São Paulo. Scenes were selected from films available at rental stores and were analyzed using a specifically designed protocol. We assessed how realistic these scenes were and their applicability for teaching. One author selected 70 scenes from 50 films (graded for realism and teaching applicability > 8). These were then rated by another two judges. Rating differences among the three judges were assessed using nonparametric tests (P 8) were defined as "quality scenes". Thirty-nine scenes from 27 films were identified as "quality scenes". Alcohol, cannabis, cocaine, hallucinogens and inhalants were included in these. Signs and symptoms of intoxication, abusive/harmful use and dependence were shown. We have produced rich teaching material for discussing psychopathology relating to alcohol and drug use that can be used both at undergraduate and at postgraduate level. Moreover, it could be seen that certain drug use behavioral patterns are deeply rooted in some Brazilian films and groups.

  17. Mobile phones as medical devices in mental disorder treatment: an overview

    DEFF Research Database (Denmark)

    Gravenhorst, Franz; Muaremi, Amir; Bardram, Jakob

    2015-01-01

    Mental disorders can have a significant, negative impact on sufferers’ lives, as well as on their friends and family, healthcare systems and other parts of society. Approximately 25 % of all people in Europe and the USA experience a mental disorder at least once in their lifetime. Currently......, monitoring mental disorders relies on subjective clinical self-reporting rating scales, which were developed more than 50 years ago. In this paper, we discuss how mobile phones can support the treatment of mental disorders by (1) implementing human–computer interfaces to support therapy and (2) collecting...... relevant data from patients’ daily lives to monitor the current state and development of their mental disorders. Concerning the first point, we review various systems that utilize mobile phones for the treatment of mental disorders. We also evaluate how their core design features and dimensions can...

  18. Specific treatment of problems of the spine (STOPS: design of a randomised controlled trial comparing specific physiotherapy versus advice for people with subacute low back disorders

    Directory of Open Access Journals (Sweden)

    Richards Matthew C

    2011-05-01

    Full Text Available Abstract Background Low back disorders are a common and costly cause of pain and activity limitation in adults. Few treatment options have demonstrated clinically meaningful benefits apart from advice which is recommended in all international guidelines. Clinical heterogeneity of participants in clinical trials is hypothesised as reducing the likelihood of demonstrating treatment effects, and sampling of more homogenous subgroups is recommended. We propose five subgroups that allow the delivery of specific physiotherapy treatment targeting the pathoanatomical, neurophysiological and psychosocial components of low back disorders. The aim of this article is to describe the methodology of a randomised controlled trial comparing specific physiotherapy treatment to advice for people classified into five subacute low back disorder subgroups. Methods/Design A multi-centre parallel group randomised controlled trial is proposed. A minimum of 250 participants with subacute (6 weeks to 6 months low back pain and/or referred leg pain will be classified into one of five subgroups and then randomly allocated to receive either physiotherapy advice (2 sessions over 10 weeks or specific physiotherapy treatment (10 sessions over 10 weeks tailored according to the subgroup of the participant. Outcomes will be assessed at 5 weeks, 10 weeks, 6 months and 12 months following randomisation. Primary outcomes will be activity limitation measured with a modified Oswestry Disability Index as well as leg and back pain intensity measured on separate 0-10 Numerical Rating Scales. Secondary outcomes will include a 7-point global rating of change scale, satisfaction with physiotherapy treatment, satisfaction with treatment results, the Sciatica Frequency and Bothersomeness Scale, quality of life (EuroQol-5D, interference with work, and psychosocial risk factors (Orebro Musculoskeletal Pain Questionnaire. Adverse events and co-interventions will also be measured. Data will be

  19. Common Versus Specific Correlates of Fifth-Grade Conduct Disorder and Oppositional Defiant Disorder Symptoms: Comparison of Three Racial/Ethnic Groups.

    Science.gov (United States)

    Wiesner, Margit; Elliott, Marc N; McLaughlin, Katie A; Banspach, Stephen W; Tortolero, Susan; Schuster, Mark A

    2015-07-01

    The extent to which risk profiles or correlates of conduct disorder (CD) and oppositional defiant disorder (ODD) symptoms overlap among youth continues to be debated. Cross-sectional data from a large, representative community sample (N = 4,705) of African-American, Latino, and White fifth graders were used to examine overlap in correlates of CD and ODD symptoms. About 49 % of the children were boys. Analyses were conducted using negative binomial regression models, accounting for several confounding factors (e.g., attention deficit/hyperactivity disorder symptoms), sampling weights, stratification, and clustering. Results indicated that CD and ODD symptoms had very similar correlates. In addition to previously established correlates, several social skills dimensions were significantly related to ODD and CD symptoms, even after controlling for other correlates. In contrast, temperamental dimensions were not significantly related to CD and ODD symptoms, possibly because more proximal correlates (e.g., social skills) were also taken into account. Only two factors (gender and household income) were found to be specific correlates of CD, but not ODD, symptoms. The pattern of common and specific correlates of CD and ODD symptoms was replicated fairly consistently across the three racial/ethnic subgroups. Implications of these findings for further research and intervention efforts are discussed.

  20. DSM-5 cannabis use disorder, substance use and DSM-5 specific substance-use disorders: Evaluating comorbidity in a population-based sample.

    Science.gov (United States)

    Hayley, Amie C; Stough, Con; Downey, Luke A

    2017-08-01

    Cannabis use disorder (CUD) is frequently associated with concurrent substance use and/or comorbid substance use disorders (SUDs); however there is little specificity with regard to commonly abused individual drug types/classes. This study therefore aimed to provide insight into the degree of these co-occurring relationships across several specific newer and older generation illicit and prescription drugs. 36,309 adults aged 18+ from wave 3 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III) were assessed. Weighted cross-tabulations and multivariable logistic regression analyses were used to evaluate comorbidity between current DSM-5 CUD, substance use and DSM-5 SUD. Current DSM-5 CUD is associated with greater lifetime use of all examined drug classes, and previous 12-month use of several newer-class illicit and prescription stimulant-based substances (all pDSM-5 CUD was similarly associated with increased incidence of a range of DSM-5 SUDs and was independently associated with concurrently reporting current DSM-5; sedative (Adjusted OR= 5.1, 95%CI 2.9-9.0), cocaine (AOR= 9.3, 95%CI 5.6-15.5), stimulant (AOR= 4.3, 95%CI 2.3-7.9), club drug (AOR= 16.1, 95%CI 6.3-40.8), opioid (AOR= 4.6, 95%CI 3.0-6.8) and alcohol-use disorder (AOR= 3.0, 95%CI 2.5-3.7); but not heroin or 'other' drug use disorder (both p>0.05). High comorbidity exists between DSM-5 CUD and many specific DSM-5 SUDs. Newer-class illicit and prescription stimulant-based drug use disorders are overrepresented among those with DSM-5 CUD. These findings underscore the need for tailored treatment programs for those presenting with DSM-5 CUD, and for greater treatment specification where poly-drug use is evident. Copyright © 2017 Elsevier B.V. and ECNP. All rights reserved.

  1. Tinnitus with temporomandibular joint disorders: a specific entity of tinnitus patients?

    Science.gov (United States)

    Vielsmeier, Veronika; Kleinjung, Tobias; Strutz, Jürgen; Bürgers, Ralf; Kreuzer, Peter Michael; Langguth, Berthold

    2011-11-01

    Tinnitus is frequently associated with temporomandibular joint (TMJ) dysfunction. However, the nature of the relationship is not fully understood. Here the authors compared 30 patients with a confirmed diagnosis of temporomandibular joint dysfunction and tinnitus to a group of 61 patients with tinnitus but without any subjective complaints of TMJ dysfunction with respect to clinical and demographic characteristics. Case-control study. Tertiary referral center. Tinnitus patients with and without TMJ dysfunction presenting at the Department of Prosthetic Dentistry and th: Tinnitus Clinic at the University of Regensburg. Tinnitus patients with TMJ disorder had better hearing function (P neck movements (P = .001). Classical risk factors for tinnitus (age, male gender, hearing loss) are less relevant in tinnitus patients with TMJ disorder, suggesting a causal role of TMJ pathology in the generation and maintenance of tinnitus. Based on this finding, treatment of TMJ disorder may represent a causally oriented treatment strategy for tinnitus.

  2. Neuron-specific chromatin remodeling: a missing link in epigenetic mechanisms underlying synaptic plasticity, memory, and intellectual disability disorders.

    Science.gov (United States)

    Vogel-Ciernia, Annie; Wood, Marcelo A

    2014-05-01

    Long-term memory formation requires the coordinated regulation of gene expression. Until recently nucleosome remodeling, one of the major epigenetic mechanisms for controlling gene expression, had been largely unexplored in the field of neuroscience. Nucleosome remodeling is carried out by chromatin remodeling complexes (CRCs) that interact with DNA and histones to physically alter chromatin structure and ultimately regulate gene expression. Human exome sequencing and gene wide association studies have linked mutations in CRC subunits to intellectual disability disorders, autism spectrum disorder and schizophrenia. However, how mutations in CRC subunits were related to human cognitive disorders was unknown. There appears to be both developmental and adult specific roles for the neuron specific CRC nBAF (neuronal Brg1/hBrm Associated Factor). nBAF regulates gene expression required for dendritic arborization during development, and in the adult, contributes to long-term potentiation, a form of synaptic plasticity, and long-term memory. We propose that the nBAF complex is a novel epigenetic mechanism for regulating transcription required for long-lasting forms of synaptic plasticity and memory processes and that impaired nBAF function may result in human cognitive disorders. Copyright © 2013 Elsevier Ltd. All rights reserved.

  3. The medicalization of society: on the transformation of human conditions into treatable disorders

    National Research Council Canada - National Science Library

    Conrad, Peter

    2007-01-01

    ... 197This page intentionally left blank PrefacePreface I have been interested in the medicalization of society for a long time. My Ph.D. dissertation was a participant observation study of the medicalization of hyperactivity in children (Conrad, 1976). This was followed by a more historical account of the medicalization of deviance, coau...

  4. [Cerebrotendinous xanthomatosis is a rare disorder, which requires a specific treatment].

    Science.gov (United States)

    Blaabjerg, Morten; Marjanovic, Dragan

    2013-01-28

    Cerebrotendinous xanthomatosis (CTX) is a rare, but treatable lipid storage disorder caused by mutation in the CYP27A1 gene. The disorder results in deposition of cholestanol in various tissues. The classical CTX phenotype includes diarrhoea, juvenile cataract, xanthoma and progressive neurological symptoms. Studies have shown that progression of symptoms can be halted or even reversed, if treatment with chenodeoxycholic acid is initiated early. The diagnosis of CTX is often delayed due to lack of awareness of the disease. We describe the history, clinical features, biochemical, genetic and magnetic resonance imaging findings of the first reported case of CTX in Denmark.

  5. A composite screening tool for medication reviews of outpatients: general issues with specific examples.

    NARCIS (Netherlands)

    Smet, P.A.G.M. de; Denneboom, W.; Kramers, C.; Grol, R.P.T.M.

    2007-01-01

    Regular performance of medication reviews is prominent among methods that have been advocated to reduce the extent and seriousness of drug-related problems, such as adverse drug reactions, drug-disease interactions, drug-drug interactions, drug ineffectiveness and cost ineffectiveness. Several

  6. Specific Disgust Sensitivities Differentially Predict Interest in Careers of Varying Procedural-Intensity among Medical Students

    Science.gov (United States)

    Consedine, Nathan S.; Windsor, John A.

    2014-01-01

    Mismatches between the needs of public health systems and student interests have led to renewed study on the factors predicting career specializations among medical students. While most work examines career and lifestyle values, emotional proclivities may be important; disgust sensitivity may help explain preferences for careers with greater and…

  7. The evaluation-mediation hypothesis: does the specification of potential side effects influence the perceived risk of medication?

    International Nuclear Information System (INIS)

    Reimer, T.

    1998-01-01

    Full text of publication follows: starting from the assumptions of support theory, this project analyzed the extent to which the specification of potential side effects influences the perceived risk associated, with a particular medication. Respondents were presented with an instruction leaflet for a medication which indicated (a) the overall probability that a side effect will occur or (b) the probability of occurrence of several specific side effects. Support theory predicts that the cognitive availability of potential side effects and therefore the perceived risk increases as a function of the specificity with which the side effects are presented. In contrast the evaluation-mediation hypothesis predicts that a more detailed presentation of potential side effects enhances the perceived quality of the information leaflet and thereby leads to a reduction of perceived risk. Support for the evaluation-mediation hypothesis was found in a series of studies which included the editing hypothesis and the elaboration likelihood model as additional explanations: the more detailed the information about potential side effects, the lower the estimated risk of suffering a side effect on taking the medication. As predicted, the influence of presentation specificity on perceived risk was mediated almost exclusively by the perceived quality of the information leaflet. A current series of studies seeks to support the evaluation-mediation hypothesis in a completely different domain, the perceived risk of environmental pollution by motor vehicles. (author)

  8. Risk factors associated with musculoskeletal disorders of the neck and shoulder in the personnel of Kerman University of Medical Sciences.

    Science.gov (United States)

    Madadizadeh, Farzan; Vali, Leila; Rafiei, Sima; Akbarnejad, Zahra

    2017-05-01

    Musculoskeletal disorders (MSDs) of the neck and shoulder are the most common and most influential factors causing disorder in the performance and absenteeism of work in administrative personnel. To identify risk factors which affect musculoskeletal disorders of neck and shoulder areas in headquarters staff of Kerman University of Medical Sciences. The present cross-sectional study was conducted in 2015 on 282 headquarters personnel of Kerman University of Medical Sciences (Kerman, Iran). The desired headquarters staff were selected from seven Deputy Vice-Chancellors of Kerman University of Medical Sciences, including Deputy of Health; Deputy of Treatment; Deputy of Education; Deputy of Students and Cultural Affairs; Deputy of Food and Drugs; Deputy of Management Development and Resource Planning; Deputy of Research and Technology, and data were gathered by using a standard Nordic musculoskeletal questionnaire NMQ (Nordic) and were analyzed by using SPSS version 16. The impact of various factors on the most common complications (neck and shoulder pains) was analyzed separately through logistic regression analysis and detailed Odds Ratio (OR) was calculated for each individual. The occurrence of neck and shoulder pains in headquarters staff were 42.14% and 40.71%, respectively. In the prevalence of neck pain variables such as marital status (single than married p=0.01, OR=0.24), work experience (p=0.03, OR=1.07 ), education (bachelor's degree and lower than master's degree and higher p=0.003, OR=2.69), right / left-handedness (left than right p=0.03, OR=0.33), weight (p=0.04, OR=1.04), place of work (prisk factors and some of which were identified and an amount of their influence in this study was found. Therefore, it is suggested by considering the risk factors and planning control programs, a major step is taken in reducing the musculoskeletal disorders of office staff.

  9. Specific biases for identifying facial expression of emotion in children and adolescents with conversion disorders.

    Science.gov (United States)

    Kozlowska, Kasia; Brown, Kerri J; Palmer, Donna M; Williams, Lea M

    2013-04-01

    This study aimed to assess how children and adolescents with conversion disorders identify universal facial expressions of emotion and to determine whether identification of emotion in faces relates to subjective emotional distress. Fifty-seven participants (41 girls and 16 boys) aged 8.5 to 18 years with conversion disorders and 57 age- and sex-matched healthy controls completed a computerized task in which their accuracy and reaction times for identifying facial expressions were recorded. To isolate the effect of individual emotional expressions, participants' reaction times for each emotion (fear, anger, sadness, disgust, and happiness) were subtracted from their reaction times for the neutral control face. Participants also completed self-report measures of subjective emotional distress. Children/Adolescents with conversion disorders showed faster reaction times for identifying expressions of sadness (t(112) = -2.2, p = .03; 444 [609] versus 713 [695], p = .03) and slower reactions times for happy expressions (t(99.3) = 2.28, p ≤ .024; -33 [35] versus 174 [51], p = .024), compared with controls (F(33.75, 419.81) = 3.76, p .018). There were also no differences in identification accuracy for any emotion (p > .82). The observation of faster reaction times to sad faces in children and adolescents with conversion disorders suggests increased vigilance and motor readiness to emotional signals that are potential threats to self or to close others. These effects may occur before conscious processing.

  10. Brief Report: Face-Specific Recognition Deficits in Young Children with Autism Spectrum Disorders

    Science.gov (United States)

    Bradshaw, Jessica; Shic, Frederick; Chawarska, Katarzyna

    2011-01-01

    This study used eyetracking to investigate the ability of young children with autism spectrum disorders (ASD) to recognize social (faces) and nonsocial (simple objects and complex block patterns) stimuli using the visual paired comparison (VPC) paradigm. Typically developing (TD) children showed evidence for recognition of faces and simple…

  11. Generic versus disorder specific cognitive behavior therapy for social anxiety disorder in youth: A randomized controlled trial using internet delivery.

    Science.gov (United States)

    Spence, Susan H; Donovan, Caroline L; March, Sonja; Kenardy, Justin A; Hearn, Cate S

    2017-03-01

    The study examined whether the efficacy of cognitive behavioral treatment for Social Anxiety Disorder for children and adolescents is increased if intervention addresses specific cognitive and behavioral factors linked to the development and maintenance of SAD in young people, over and above the traditional generic CBT approach. Participants were 125 youth, aged 8-17 years, with a primary diagnosis of SAD, who were randomly assigned to generic CBT (CBT-GEN), social anxiety specific CBT (CBT-SAD) or a wait list control (WLC). Intervention was delivered using a therapist-supported online program. After 12-weeks, participants who received treatment (CBT-SAD or CBT-GEN) showed significantly greater reduction in social anxiety and post-event processing, and greater improvement in global functioning than the WLC but there was no significant difference between CBT-SAD and CBT-GEN on any outcome variable at 12-weeks or 6-month follow-up. Despite significant reductions in anxiety, the majority in both treatment conditions continued to meet diagnostic criteria for SAD at 6-month follow-up. Decreases in social anxiety were associated with decreases in post-event processing. Future research should continue to investigate disorder-specific interventions for SAD in young people, drawing on evidence regarding causal or maintaining factors, in order to enhance treatment outcomes for this debilitating condition. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. Medications Used for Cognitive Enhancement in Patients With Schizophrenia, Bipolar Disorder, Alzheimer’s Disease, and Parkinson’s Disease

    Directory of Open Access Journals (Sweden)

    Wen-Yu Hsu

    2018-04-01

    Full Text Available Background/aimsCognitive impairment, which frequently occurs in patients with schizophrenia, bipolar disorder, Alzheimer’s disease, and Parkinson’s disease, has a significant impact on the daily lives of both patients and their family. Furthermore, since the medications used for cognitive enhancement have limited efficacy, the issue of cognitive enhancement still remains a clinically unsolved challenge.Sampling and methodsWe reviewed the clinical studies (published between 2007 and 2017 that focused on the efficacy of medications used for enhancing cognition in patients with schizophrenia, bipolar disorder, Alzheimer’s disease, and Parkinson’s disease.ResultsAcetylcholinesterase inhibitors and memantine are the standard treatments for Alzheimer’s disease and Parkinson’s disease. Some studies have reported selective cognitive improvement in patients with schizophrenia following galantamine treatment. Newer antipsychotics, including paliperidone, lurasidone, aripiprazole, ziprasidone, and BL-1020, have also been reported to exert cognitive benefits in patients with schizophrenia. Dopaminergic medications were found to improve language function in patients with Parkinson’s disease. However, no beneficial effects on cognitive function were observed with dopamine agonists in patients with schizophrenia. The efficacies of nicotine and its receptor modulators in cognitive improvement remain controversial, with the majority of studies showing that varenicline significantly improved the cognitive function in schizophrenic patients. Several studies have reported that N-methyl-d-aspartate glutamate receptor (NMDAR enhancers improved the cognitive function in patients with chronic schizophrenia. NMDAR enhancers might also have cognitive benefits in patients with Alzheimer’s disease or Parkinson’s disease. Raloxifene, a selective estrogen receptor modulator, has also been demonstrated to have beneficial effects on attention, processing

  13. Preservation of person-specific knowledge in semantic memory disorder: a longitudinal investigation in two cases of dementia.

    Science.gov (United States)

    Haslam, Catherine; Sabah, Mazen

    2013-03-01

    The double dissociation involving person-specific and general semantic knowledge is supported by numerous patient studies, though cases with preservation of the former are few. In this paper, we report longitudinal data from two cases. Their knowledge in both domains was preserved at the start of the investigation, but progressive deterioration was primarily observed on tests of general semantics. These data strengthen the evidence-base for preservation of person-specific knowledge in semantic memory disorder, and support its separate representation from object knowledge. © 2012 The British Psychological Society.

  14. Is there a need for a specific educational scholarship for using e-learning in medical education?

    Science.gov (United States)

    Sandars, John; Goh, Poh Sun

    2016-10-01

    We propose the need for a specific educational scholarship when using e-learning in medical education. Effective e-learning has additional factors that require specific critical attention, including the design and delivery of e-learning. An important aspect is the recognition that e-learning is a complex intervention, with several interconnecting components that have to be aligned. This alignment requires an essential iterative development process with usability testing. Effectiveness of e-learning in one context may not be fully realized in another context unless there is further consideration of applicability and scalability. We recommend a participatory approach for an educational scholarship for using e-learning in medical education, such as by action research or design-based research.

  15. Specification and Verification of Medical Monitoring System Using Petri-nets.

    Science.gov (United States)

    Majma, Negar; Babamir, Seyed Morteza

    2014-07-01

    To monitor the patient behavior, data are collected from patient's body by a medical monitoring device so as to calculate the output using embedded software. Incorrect calculations may endanger the patient's life if the software fails to meet the patient's requirements. Accordingly, the veracity of the software behavior is a matter of concern in the medicine; moreover, the data collected from the patient's body are fuzzy. Some methods have already dealt with monitoring the medical monitoring devices; however, model based monitoring fuzzy computations of such devices have been addressed less. The present paper aims to present synthesizing a fuzzy Petri-net (FPN) model to verify behavior of a sample medical monitoring device called continuous infusion insulin (INS) because Petri-net (PN) is one of the formal and visual methods to verify the software's behavior. The device is worn by the diabetic patients and then the software calculates the INS dose and makes a decision for injection. The input and output of the infusion INS software are not crisp in the real world; therefore, we present them in fuzzy variables. Afterwards, we use FPN instead of clear PN to model the fuzzy variables. The paper follows three steps to synthesize an FPN to deal with verification of the infusion INS device: (1) Definition of fuzzy variables, (2) definition of fuzzy rules and (3) design of the FPN model to verify the software behavior.

  16. Medical Management of U