To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
This interview took place during the Edinburgh Fringe Festival (August 2017), where Impromptu Shakespeare has been performing since 2013. An improvised theatre group, Impromptu Shakespeare weaves in one new ‘Shakespeare’ play at every show. The conversation was led by Marina Cano, as part of her research on improvised Shakespeare and improvised Jane Austen. It involved Impromptu actors Ailis Duff and Rebecca MacMillan, and touched upon matters of improvisation, methodology, adaptation, Shakespeare on stage, and gender-blind performance. Marina Cano is a Research Associate at the University of Limerick, Ireland. She is the author of Jane Austen and Performance (Palgrave 2017) and the co-editor of Jane Austen and William Shakespeare: A Love Affair in Literature, Film, and Performance (Palgrave 2019).
In response to the rapid spread of novel coronavirus disease 2019 (COVID-19), health-care systems should establish procedures for early recognition and management of suspected or confirmed cases. We describe the various steps taken for the development, implementation, and dissemination of the interdisciplinary COVID-19 protocol at Jackson Health System (JHS), a complex tertiary academic health system in Miami, Florida. Recognizing the dynamic nature of COVID-19, the protocol addresses the potential investigational treatment options and considerations for special populations. The protocol also includes infection prevention and control measures and routine care for suspected or proven COVID-19 patients.
Maternal obesity (MO) during pregnancy and lactation leads to maternal and offspring metabolic dysfunction. Recent research has suggested that probiotics might be a novel approach to counteract these unwanted MO effects. The aim of this research was to analyze the impact of Leuconostoc SD23, a probiotic isolated from aguamiel (traditional Mexican drink), on MO metabolism in rats at the end of lactation (21 days). From weaning through lactation, control female Wistar rats (C) ate chow (5% fat) or high-energy obesogenic diet (MO; 25% fat). Half the C and MO mothers received a daily dose (1 × 1010 CFU/ml) of probiotic orally, control with probiotic (CP) and MO with probiotic (MOP), 1 month before mating and through pregnancy and lactation. Histological analyses of the liver, white adipose tissue and small intestine, body composition, glucose, insulin, triglycerides, and leptin were determined in mothers at the end of lactation. Maternal weight during pregnancy was greater in MO than C mothers, but similar at the end of lactation. Probiotic intervention had no effect on maternal weight. However, at the end of lactation, percentage of body fat was higher in MO than C, CP, and MOP. Serum glucose, homeostasis model assessment of insulin resistance, and triglycerides were higher in MO versus C, CP, and MOP. MO small intestine villus height was higher versus MOP, C, and CP. Leuconostoc SD23 did not present adverse effects in C. Conclusions: maternal administration of Leuconostoc SD23 has beneficial effects on maternal metabolism, which holds possibilities for preventing adverse offspring metabolic programming.
Recent international communicable disease crises have highlighted the need for countries to assure their preparedness to respond effectively to public health emergencies. The objective of this study was to critically review existing tools to support a country’s assessment of its health emergency preparedness. We developed a framework to analyze the expected effectiveness and utility of these tools. Through mixed search strategies, we identified 12 tools with relevance to public health emergencies. There was considerable consensus concerning the critical preparedness system elements to be assessed, although their relative emphasis and means of assessment and measurement varied considerably. Several tools identified appeared to have reporting requirements as their primary aim, rather than primary utility for system self-assessment of the countries and states using the tool. Few tools attempted to give an account of their underlying evidence base. Only some tools were available in a user-friendly electronic modality or included quantitative measures to support the monitoring of system preparedness over time. We conclude there is still a need for improvement in tools available for assessment of country preparedness for public health emergencies, and for applied research to increase identification of system measures that are valid indicators of system response capability.
Sexuality is a crucial area of human life. A proper examination to assess and detect problems in this field, it seems imperative to intervene when transsexual patients. Therefore accurately known, the sexual practices of these patients, allows us to work directly on possible alterations in the functioning of sexual life during the therapeutic process.
Describe patterns of sexual behavior in patients diagnosed with transsexualism
Gender and Identity Disorder Unit (GIDU)
Selected by consecutive sampling, 200 transsexuals treated at GIDU Malaga, aged between 20 and 40 years and who agreed to participate in the study. Comprising 142 transgender male-to-woman (MtW) and 58 women-to-man (WtM).
Was conducted through a heterocompleted questionnaire that included questions about sexuality, personality traits and demographic characteristics. These were filled in the consultation and were anonymous.
11.6% of MtW transsexuals have never had sex. 26.8% of the MtW and 29% of WtM are more than 3 months without masturbating. 54.1% of the MtW avoid having sex due to the rejection of his genitals, lack of sexual desire and previous traumatic experience. Transgender respondents had secondary education, stable jobs and they were single.
It is vital that we explore the sex lives of transsexual patients. This information must be integrated in a systematic and rigorous evaluation process. According to the results presented, the hyposexuality would be the most significant feature that describes sexuality for this population.
En France, le suivi sanitaire des sujets condamnés pour des infractions sexuelles en milieu ouvert ambulatoire s’effectue généralement dans le cadre des soins pénalement ordonnés.
Les prises en charge de ces auteurs se heurtent régulièrement à des difficultés diverses comme la question sensible de la formulation de la demande de suivi par les patients a partie de la laquelle émergent les dimensions de volonté de changement et de motivation au traitement. Considérant le modèle motivationnel de Miller et Rollnick , il est fréquent de constater que les auteurs de violences sexuelles se situent généralement aux stades de pré-contemplation et de contemplation de leurs difficultés et que les facteurs motivationnels au changement sont surtout extrinsèques.
La motivation étant un phénomène complexe divers facteurs semblent impliqués dans l’amorce du changement. La littérature reconnaît la présence de facteurs sociodémographiques, liés à l’individu et liés à l’environnement.
Parmi les solutions proposées à l’accès au changement la thérapie sous contrainte semble être privilégiée. On attend de celle-ci qu’elle soit le moteur d’une évolution du fonctionnement du patient qui se traduirait par exemple par une modification du discours les faits, la considération de la victime par l’auteur… .
L’adaptation des techniques d’entretien motivationnel apporterait des bénéfices dans le suivi de ces patients, en termes d’adaptation aux rythmes individuels, d’engagement et de responsabilisation . Cela proposerait un outil thérapeutique pertinent, et resituerait l’approche motivationnelle dans le mouvement d’approches dites « positives » développées depuis quelques années.
Ce poster se propose d’aborder la question de la motivation au changement des auteurs de violences sexuelles à travers des rappels théoriques de la théorie du changement, des facteurs impliqués dans le changement des AVS et une application clinique de cette méthode du changement.
There is a growing concern about satisfaction with inpatient psychiatric services. There are currently numerous satisfaction instruments available to psychiatric inpatients, but little guidance on which among them to select.
To provide an overview of the psychometric properties and the content of satisfaction instruments available to psychiatric inpatients.
Systematic searches of Medline database to identify inpatient satisfaction questionnaires. Assessment of the instruments according to relevant psychometric properties.
Fifteen satisfaction instruments were identified. The target population differed according to the instrument. Methods used to generate items were heterogeneous. These instruments were based on a mixed approach including patients’ points of view, expert opinions, and literature reviews, causing the content of questionnaires to vary. Reliability and validity were not systematically tested.
The validation of a common inpatient satisfaction instrument is a major challenge. Recommendations for the future development of satisfaction instruments may include: item generation based exclusively on the patient's point of view; a validation process on a large and representative population; and an instrument combining generic (core questionnaire) and specific (additional modules) approaches.
The aim of the present study is to see if the changes in the regional cerebral blood flow (rCBF) experienced by restrictive anorexia nervosa (AR) and bulimia nervosa (BN) patients, following the exposure to their own body image, persist at follow-up.
Three single photon emission computed tomography (SPECT) were performed on nine patients with a DSM-IV diagnosis of AR, 13 with BP, and 12 controls: at rest, following a neutral stimulus, and after exposure to their previously filmed whole body image. Body dissatisfaction was measured by means of the Body Dissatisfaction Questionnaire (BSQ). One year later the same assessment was repeated.
Following the exposure to their own body image, BN showed an increase in body dissatisfaction, which was associated with the increase in the rCBF of the Right Temporal Area. Those changes persisted at follow-up.
More specific long term therapies are needed for the treatment of the averse response showed by ED patients to their own body image exposure that is associated with the hyperactivation of the right temporal area when they are confronted with their whole body image.
To estimate the overall annual incidence and age group distribution of eating disorders in a representative sample of adolescent female residents of Navarra, Spain.
We studied a representative sample of 2734 adolescent Navarran females between 13 and 22 years of age who were free of any eating disorder at the start of our study. Eighteen months into the study, we visited the established centers and the eating attitudes test (EAT-40) and eating disorder inventory (EDI) Questionnaires were administered to the entire study population. We obtained a final response of 92%. All adolescents whose EAT score was over 21 points and a randomized sample of those who scored 21 or below, were interviewed. Any person meeting the DSM-IV diagnostic criteria for Anorexia Nervosa (AN), Bulimia Nervosa (BN) or eating disorder not otherwise specified (EDNOS) was considered a case.
We detected 90 new cases of eating disorders. Taking into consideration the randomly selected group whose EAT score was 21 points or below, we estimated the overall weighted incidence of eating disorders to be 4.8% (95% CI: 2.8–6.8), after 18 months of observation, in which EDNOS predominated with an incidence of 4.2% (95% CI: 2.0–6.3). The incidence of AN was 0.3% (95% CI: 0.2–0.5), while that of BN was also found to be 0.3% (95% CI: 0.2–0.5). The highest incidence was observed in the group of adolescents between 15 and 16 years of age.
The overall incidence of ED in a cohort of 2509 adolescents after 18 months of follow-up was 4.8% (95% CI: 2.8–6.8), with EDNOS outweighing the other diagnoses. The majority of new cases of eating disorders were diagnosed between ages 15 and 16.
Counterfactual thoughts (CFT) are mental representations of alternatives to past events, actions or states. For example, “If only I had studied, I would have passed the exam”).
CFT in healthy subjects is associated with learning, behavioral regulation and planning.
Damage to the prefrontal brain regions has been related to decreased generation and use of CFT. Due to the fact that frontal deficits are documented in patients with schizophrenia, it is expected that these patients could also present impairments in CFT.
The aim of our study was to examine the role of the generation of CFT in schizophrenia patients.
Forty subjects who met DSM-IV criteria for schizophrenia and 40 healthy control participants were recruited. The two groups were matched in age, education, and handedness.
To investigate the generation of CTF we used an adaptation of the task made by Wells, Taylor & Turtle (1987). In this task, we presented to the subjects one history with 4 different scenarios. After the presentation of the history, we asked to the subjects that list alternatives to solve the problem presented in the history.
The schizophrenic patients generated less responses of CTF that controls. The patients obtained a mean of responses of 1.48 (1 SD). The mean for the controls was 2.08 (.971 SD). The control subjects generated significantly more counterfactual responses than schizophrenic patients ([t (78) = −2.670, p = .269]).
Our findings indicate that patients with schizophrenia have impoverished the generation of CFT compared to normal control participants.
Although the epidemiology of Eating Disorders (ED) has been highly developed in Spain, further research considering false negatives and also the prevalence of these disorders in males are needed. They were the aims of the present study.
One thousand and seventy six adolescents (500 males and 576 females) participated in a two-stage survey. At the age of 13, apart from exploring numerous clinical and psychosocial variables, they were assessed by means of self-administered screening instruments, the eating attitude test (EAT), bulimic investigatory test Edinburgh (BITE), and body shape questionnaire (BSQ). The subjects were interviewed again 2 years later. Afterwards, 159 probable cases and 150 controls were interviewed by means of the structured interview SCAN.
Prevalence of ED in adolescents was 3.71% (95% CI 2.58–4.83; 6.4% of females, 0.6% of males): anorexia nervosa 0.1%, bulimia nervosa 0.75%, eating disorder not otherwise specified (EDNOS) = 2.88%. The rate of false negative was 2.6% of the control group and most of them were EDNOS.
The prevalence of ED obtained in our study, higher than others found in previous Spanish research, and a relatively high percentage of false negatives both indicate that up to now the prevalence of ED in Spanish adolescents could be underestimated.
The ECT it continues being one of the principal treatments available and used in Psychiatry for the serious mental illnesses. A considerable variability exists between physicians and between geographical regions with regard to the use of the ECT as treatment of the first line or only of secondary form when the patients do not answer to other interventions.
The ‘therapeutic inhibition’ largely can be due to a stigma that is based on antiquated and old-fashioned beliefs to near the treatment, in spite of that the utilization of the ECT has been supported by numerous studies.
This practice can deprive the patients of an effective treatment, delay the response and prolong the suffering and possibly contribute to the resistance to the treatment.
With this study one tries to know the characteristics and diagnostic indications of all the patients who have been attended in the unit of Mental Health of the hospitable complex of Albacete, which they have needed treatment with ECT.
A descriptive study is realized, observacional, restrospectivo by a group of patients who have been necessary the ECT in a period of study understood between 3/4/2008 to 31/10/2013. Variables will be analyzed sociodemográficas and diagnostic as; Distribution for age, sex and marital status, number of meetings of received ECT, hospitable needed stay, indications for diagnosis, response to the ECT and side effects.
Schizophreniais a psychiatric disorder with multiple causes, including genetic, immune, environmental causes of various kinds, which all increase the vulnerability andpredisposition to the disorder. Among them stand out prenatal infections, thusbeing a preventable risk potential factor in our daily clinical practice.
To analyze the relation between prenatal infecions andschizophrenia.
Review of the subject and recent articles on schizophreniain Psychiatric guides and magazines.
After analyzing several studies, it have shown that prenatal infections, where the nervous system is not yet fully developed, may be a risk factorfor the development of schizophreniain adults, in relation with genetically predisposed individuals. Infections such as influenza, especiallyduring the first quarter of gestation;rubella, toxoplasma and herpes simplex virus-type 2 are related topotencially increase risk of suffer schizophrenia.
Prenatal infections, especially in the firstquarter and the periconceptional period, constitute a risk factor inindividuals with vulnerability to develop schizophrenia. Awareness andprevention is important in the pregnant population of the influence of theseinfections on the possible origin of psychotic episodes.
The substance use is common among people with a diagnosis of bipolar disorder. In addition, alcoholism and bipolar disorder coexist with a high frequency. This association is higher in men than in women, and this consumption is thefactor that most strongly influences the hospitalization.
To analyze the clinical, epidemiological, diagnostic approach and evolution of bipolar disorder andalcoholism.
Review of thesubject on recent articles of alcoholism in bipolar disorder.
The stages of mania associated with alcohol consumption up to 40% of casesand are more common at this stage that in depressive. This association isgreater than that which occurs between alcoholism and schizophrenia ordepression. Patients with bipolar disorder who have mixed and irritative statesand those with rapid cycling have a prevalence of alcohol consumption and sustanceuse higher than those who do not use substances. It has also been observed thatthe consumption of alcohol, and substance use can change the symptoms of maniaand turn them into a mixed state symptoms. It also states that rapid cycles canbe precipitated by increased alcohol consumption during rotation from mania todepression.
The associationof bipolar disorder with addictive behaviors is a factor that worsens theprognosis and comorbid alcohol itself is associated with a poor prognosis. Close monitoring of bipolar patients and especially in those who consumealcohol is very important.
Electroconvulsive therapy (ECT) is the most effective and fast acting therapy for treatment-resistant depression (TRD). Animal research has consistently pointed to neuroplasticity as a central mechanism of ECT action (1), however evidence in humans remains scarce (2; 3).
We assessed two independent samples of TRD patients referred for ECT. The Barcelona-sample included 13 subjects treated with bitemporal ECT and 10 healthy volunteers (HV). Four successive 3T structural MRIs were acquired: baseline, 24-48 hours after the 1st ECT session, 24-48 hours after the 9th ECT, and two weeks after ECT course completion. HV were scanned twice five weeks apart. Within the framework of the Barcelona-Sydney Clinical Imaging Collaboration, we also scanned 10 patients treated mainly with right unilateral ECT (Sydney-sample). Whole-brain longitudinal grey matter (GM) changes were measured using intra-subject diffeomorphic registration, within SPM12b.
In the Barcelona-sample, over the course of treatment bitemporal ECT produced a linear increase of GM volume in the limbic system (involving bilateral hippocampi and amygdalae). Additionally, volumetric increase within the right subgenual cortex was detected from baseline to the 9th ECT session. Such volume changes were not observed in HV. Furthermore, GM volume expansion correlated positively with depressive symptom improvement and neurocognitive performance (memory and executive function). Hippocampal and amygdalar volume increases were replicated in the Sydney-sample, although limited to the stimulated hemisphere.
ECT effects described here could be accounted for by the induction of regionally specific structural plasticity. Nevertheless, other mechanisms such as neurovascular changes should not be discarded.
Behavioural symptoms are the first reason of psychiatric assessment in patients with intellectual disabilities (ID), and also the most frequent cause of psychopharmacological treatment. Different rates of prevalence of these symptoms appear in literature data (10-60%). Paliperidone has shown effectiveness in the treatment of behavioural symptoms in patients with autism and asperger syndrome, with significant reduction in ABC-I subscale scores.
Study paliperidone effect in behavioural symptoms' improvement in patients with intellectual disabilities of diverse etiology.
10 outpatients with intellectual disabilities and behavioral symptoms were selected and treated with paliperidone. Sociodemographic and clinical data (type of intellectual disability, previous antipsychotic and paliperidone dose) were registered. Agitation subscale Aberrant Behavior Checklist (ABC-I) scores were compared prior and 4 weeks after psychopharmacological treatment change. Otherwise we assessed clinical improvement with Clinical Global Impression-Improvement (CGI-I).
All patients were similar in clinical and sociodemographic characteristics. Paliperidone mean dose was 8,4 mg/day (3-18 mg/day), changing from risperidone (44,4%), olanzapine (44,4%) and levomepromacine (11,1%). Mean reduction in ABC-I scores with paliperidone treatment was 6,2 points [with most significant improvement in items like irritability (1,2 points), aggressions (1,1 points) and slams (0,9 points)]. CGI-I scores showed a much better improvement in 60% patients, mildly betterin 30% patients and slightly better in 10% patients. No significant adverse effects leaded to treatment discontinuation.
1. Paliperidone is an effective and safe treatment in behavioral symptoms associated to intellectual disabilities.
2. Paliperidone treatment reduces ABC-I subscale scores, with most significant improvement in irritability and aggressions.
Disorders of eating behavior can affect all people regardless of socioeconomicor cultural situation. More common in females (90-95 %), has its peak incidencein adolescence. These are processes that can subtly start and go unnoticed atfirst.
To analyze the clinical, epidemiological, diagnostic approach of the disorder, evolution and treatment of disordered eating behavior.
Review of the subject and recent articles on eating behavior disorders inPsychiatric guides and magazines.
The eating behavior disorders arise as a result of three factors: predisposing, precipitating and perpetuating. We must take into account the genetics andfamily history, dissatisfaction with body weight resulting in a restriction ofdiet and multi-disciplinary consequences of this disorder (physical, psychological and social) asperpetuating factors. We consider the coexistence of comorbidity betweendisordered eating behavior and personality disorders, mood disorders(depression) and disorders of impulse control.
Eating behavior disorders represent a major health problem that threatens thepatient's life. Very important is the rapid detection of the same and theestablishment of treatment. Treatment should be multidisciplinary with thepatient and family, providing information on the approach to the patient, takinginto account the lack of awareness of disease that often exists in patients.