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Partly as a consequence of an aging global population, radiology departments have seen an increase in imaging in patients older than 65 years of age . One department in the United Kingdom found a 51% increase in radiological studies performed in patients over 90 years of age over a recent 7-year period .
Bipolar disorder (BD) is a familial psychiatric disorder associated with frontotemporal and subcortical brain abnormalities. It is unclear whether such abnormalities are present in relatives without BD, and little is known about structural brain trajectories in those at risk.
Neuroimaging was conducted at baseline and at 2-year follow-up interval in 90 high-risk individuals with a first-degree BD relative (HR), and 56 participants with no family history of mental illness who could have non-BD diagnoses. All 146 subjects were aged 12–30 years at baseline. We examined longitudinal change in gray and white matter volume, cortical thickness, and surface area in the frontotemporal cortex and subcortical regions.
Compared to controls, HR participants showed accelerated cortical thinning and volume reduction in right lateralised frontal regions, including the inferior frontal gyrus, lateral orbitofrontal cortex, frontal pole and rostral middle frontal gyrus. Independent of time, the HR group had greater cortical thickness in the left caudal anterior cingulate cortex, larger volume in the right medial orbitofrontal cortex and greater area of right accumbens, compared to controls. This pattern was evident even in those without the new onset of psychopathology during the inter-scan interval.
This study suggests that differences previously observed in BD are developing prior to the onset of the disorder. The pattern of pathological acceleration of cortical thinning is likely consistent with a disturbance of molecular mechanisms responsible for normal cortical thinning. We also demonstrate that neuroanatomical differences in HR individuals may be progressive in some regions and stable in others.
Pre-mature birth impacts left ventricular development, predisposing this population to long-term cardiovascular risk. The aims of this study were to investigate maturational changes in rotational properties from the neonatal period through 1 year of age and to discern the impact of cardiopulmonary complications of pre-maturity on these measures.
Pre-term infants (<29 weeks at birth, n = 117) were prospectively enrolled and followed to 1-year corrected age. Left ventricular basal and apical rotation, twist, and torsion were measured by two-dimensional speckle-tracking echocardiography and analysed at 32 and 36 weeks post-menstrual age and 1-year corrected age. A mixed random effects model with repeated measures analysis was used to compare rotational mechanics over time. Torsion was compared in infants with and without complications of cardiopulmonary diseases of pre-maturity, specifically bronchopulmonary dysplasia, pulmonary hypertension, and patent ductus arteriosus.
Torsion decreased from 32 weeks post-menstrual age to 1-year corrected age in all pre-term infants (p < 0.001). The decline from 32 to 36 weeks post-menstrual age was more pronounced in infants with cardiopulmonary complications, but was similar to healthy pre-term infants from 36 weeks post-menstrual age to 1-year corrected age. The decline was due to directional and magnitude changes in apical rotation over time (p < 0.05).
This study tracks maturational patterns of rotational mechanics in pre-term infants and reveals torsion declines from the neonatal period through 1 year. Cardiopulmonary diseases of pre-maturity may negatively impact rotational mechanics during the neonatal period, but the myocardium recovers by 1-year corrected age.
Archaeologists have a responsibility to use their research to engage people and provide opportunities for the public to interact with cultural heritage and interpret it on their own terms. This can be done through hypermedia and deep mapping as approaches to public archaeology. In twenty-first-century archaeology, scholars can rely on vastly improved technologies to aid them in these efforts toward public engagement, including digital photography, geographic information systems, and three-dimensional models. These technologies, even when collected for analysis or documentation, can be valuable tools for educating and involving the public with archaeological methods and how these methods help archaeologists learn about the past. Ultimately, academic storytelling can benefit from making archaeological results and methods accessible and engaging for stakeholders and the general public. ArcGIS StoryMaps is an effective tool for integrating digital datasets into an accessible framework that is suitable for interactive public engagement. This article describes the benefits of using ArcGIS StoryMaps for hypermedia and deep mapping–based public engagement using the story of copper production in Iron Age Faynan, Jordan, as a case study.
Field studies were conducted to determine sweetpotato tolerance to and weed control from management systems that included linuron. Treatments included flumioxazin preplant (107 g ai ha−1) followed by (fb) S-metolachlor (800 g ai ha−1), oryzalin (840 g ai ha−1), or linuron (280, 420, 560, 700, and 840 g ai ha−1) alone or mixed with S-metolachlor or oryzalin applied 7 d after transplanting. Weeds did not emerge before the treatment applications. Two of the four field studies were maintained weed-free throughout the season to evaluate sweetpotato tolerance without weed interference. The herbicide program with the greatest sweetpotato yield was flumioxazin fb S-metolachlor. Mixing linuron with S-metolachlor did not improve Palmer amaranth management and decreased marketable yield by up to 28% compared with flumioxazin fb S-metolachlor. Thus, linuron should not be applied POST in sweetpotato if Palmer amaranth has not emerged at the time of application.
OBJECTIVES/GOALS: In 2016, more than 3,100 children died, and an estimated 17,000 children had non-fatal injuries, from firearms in the United States. In this study, we used hospital charges as a proxy for medical resource utilization, and compared differences in charges by intent of firearm injury among children. METHODS/STUDY POPULATION: In this cross-sectional study of the 2016 Nationwide Emergency Department Sample, we identified firearm injury cases among children aged 19 years or younger using ICD-10-CM external cause of morbidity codes. Injury intent was characterized as unintentional, assault, self-inflicted, undetermined, or due to legal intervention. We included patients treated and released from the emergency department (ED) or admitted alive to the hospital, and excluded those who were transferred or died in the ED. We used linear regressions with survey weighting to compare differences in mean healthcare charges by firearm injury intent, with and without adjustment for ED disposition. RESULTS/ANTICIPATED RESULTS: Among 12,469 cases in the weighted sample, mean age was 16.5 years, a majority were male (88.2%) and Medicaid-insured (57.8%), and 64% were discharged from the ED and 36% admitted. Injuries were 49.0% unintentional, 45.1% assault-related, and 1.8% self-inflicted. Compared to children with self-inflicted injuries (charges $115,224), children with assault-related injuries (charges $55,052; p<0.007) and unintentional injuries (charges $38,643; p<0.001) had lower mean charges per visit. Differences in charges were no longer significant after adjusting for ED disposition, as 85.8% of self-inflicted injuries were admitted, compared to 46.5% of assault-related and 24.3% of unintentional injuries. DISCUSSION/SIGNIFICANCE OF IMPACT: Although the majority of pediatric firearm-related injuries resulting in emergency department care are unintentional or assault-related, self-inflicted injuries result in greater per visit hospital charges, attributable to higher hospitalization rates, and likely due to more severe injuries.
L’utilisation prolongée et les associations de benzodiazépines (BZD) anxiolytiques et hypnotiques exposent à des risques à court et long terme (dépendance, démence, troubles psychomoteurs…). Selon la Haute Autorité de santé (HAS), il n’y a pas lieu d’associer une BZD et un apparenté (zopiclone ou zolpidem) le soir.
– Évaluer les habitudes de prescription des BZD et de leurs apparentés hypnotiques dans une population de patients suivis en psychiatrie hospitalière.
– Suivre sur 6 années l’évolution de ces pratiques de prescription et l’émergence d’alternatives thérapeutiques aux BZD.
– Établir un parallèle avec les recommandations et les actualités de la littérature au sujet de ces risques pendant cette même période.
L’étude rétrospective a été réalisée au centre hospitalier Henri-Laborit (Poitiers) en sélectionnant les ordonnances informatisées comportant des BZD et/ou apparentés sur une période allant du 1er janvier 2008 au 31 décembre 2013, par tranche d’une année. Les associations de ces molécules et leurs posologies ont été répertoriées.
L’analyse de 6511 ordonnances a notamment mis en évidence que la prescription de zolpidem ou zopiclone seuls, sans association à une benzodiazépine, est majoritaire (77,5 % des ordonnances en moyenne) jusqu’en 2010. Puis elle diminue fortement (plus que 38 % en 2013) et elle est inférieure à celle de benzodiazépine seule pendant les 3 années suivantes. Parallèlement, le nombre total d’ordonnances dans cet hôpital est en constante augmentation. L’association de benzodiazépine et d’apparentés sur une même ordonnance reste peu courante, dans 2 % des prescriptions en moyenne, mais la prise des deux se situe le soir dans 91 % des cas (69–100 %).
L’étude montre une diminution de prescription d’hypnotiques apparentés aux BZD, allant de pair avec les mises en garde sur leurs effets indésirables et aux actions de l’HAS. Leur association en soirée à des BZD reste présente et une étude prospective auprès des prescripteurs pour connaître leur choix d’alternative thérapeutique est nécessaire.
Anxiety and depression are often interlinked as demonstrated by clinical, epidemiological, psychopharmacological and even genetic studies. However, robust biochemical and electrophysiological evidence for linkage or separation of mood and anxiety disorders is scarce. Brain stem auditory evoked potentials (BASEP) can easily and non-invasivly be measured in psychiatric patients and reflect neurophysiological processes in the brain stem. The aim of the present study was to evaluate BASEP in drug-free patients suffering from panic disorder or major depression and to compare these to healthy controls. Patients (n = 26; panic = 16, depression = 10) were diagnosed according to Diagnostic and Statistical Manual (DSM)-III-R criteria assessed by the Hamilton Anxiety and Hamilton Depression Scales, and all underwent 3 weeks of medications washout. All subjects (n = 36) completed the study. N3 latency was decreased in the patient group (P < 0.05), N3-5 interval was lengthened (P < 0.05), the N3 latency correlated with anxiety scores and depression scores correlated with the N3 and N5 latency periods. In conclusion, our small sample demonstrated shared electrophysiological variables in panic disorder and depression, further supporting the concept of spectrum disorder.
Early intervention in psychosis constitutes an important opportunity to change the classic limited outcome associated with the patients who suffer of psychotic disease.
Based on literature review the authors analyse the evidence for early intervention in first psychotic episode.
The evidence for the effectiveness of interventions in early psychosis can be considered in two stages:
1. first stage before the onset of full symptoms of psychosis, in people with high risk of developing psychosis or in the prodrome phase of the illness;
2. second stage includes the therapeutic focus on the period after the first psychotic episode, reducing the duration of untreated psychosis (DUP) and ameliorate the recovery.
Preventing psychosis by intervene in the prodrome or in people with high risk of developing psychosis remains ethically contentious because of the non-specificity of the symptoms. by the contrary there is evidence that early and specialised intervention in first psychotic episode improves outcome. Besides the controversy of the relation between long DUP and poor outcome, there is agreement that clinicians should identify and treat psychosis early with a great impact in patients and their family's life. Effective care during first psychotic episode includes proactive engagement and initiation of low doses of antipsychotics and psychosocial treatments, aiming for maximal symptomatic and functional recovery and the prevention of relapse.
There is evidence that early intervention in first psychotic episode improve clinical effectiveness over standard care. Further studies are important to make evidence more robust.
Since reports have underscored that panic attacks (PA) may be an identifiable state occurring in schizophrenia, we studied the symptomatology of PA in a group of schizophrenic patients. Of 40 patients (21 males and 19 females) attending a clinic for maintenance therapy of schizophrenia, 19 (36.8%) had a lifetime history of PA. Seven among those 19 patients (36.8%) had or had had spontaneous panic attacks, not related to phobic fears or delusional fears, and for the 12 remaining patients, the PA were related to paranoid ideas. Moreover, the paranoid subtype of schizophrenia tends to be more often associated with a history of panic attack than other subtypes of schizophrenia (52.6% vs 23.8%; χ2 = 3.5, P = .06). It seems that there are at least two types of PA in schizophrenic patients. The first one could be independent from the psychotic feature, with no psychopathological link. The second kind of PA could be directly related to a schizophrenic disorder, and found in patients with the paranoid subtype.
Longtemps la profession médicale a été perçue comme une « vocation » qu’on embrassait comme on rentrait dans les ordres ou en religion… Cette représentation faisait du médecin un être à part, un peu « désincarné ». De plus si on se réfère à Hippocrate – que tout jeune médecin thésard découvrira à travers son serment – : « le médecin aura une bonne couleur et de l’embonpoint, car la foule s’imagine que ceux dont le corps n’est pas aussi en bon état, ne saurait soigner convenablement les autres ». Ce précepte encore actuel, a donné naissance à des générations de médecins – super héros, dévoués entièrement à l’humanité souffrante mais souvent au détriment de leur propre santé. Et pourtant conserver un corps et un esprit sains est indispensable pour soigner les autres. Prendre soin de soi pour prendre soin de l’autre devrait être enseigné dès les études de médecine et rester le mot-clé du médecin durant toute sa carrière. En effet très vite on pensera au « médecin blessé » dont C.G. Jung parla le premier en 1951. Il reprit le mythe de Chiron, père de la Médecine et maître d’Esculape qui considérait comme le redira Platon que « les plus habiles des médecins seraient ceux qui n’étant pas eux-mêmes d’une complexion saine, auraient souffert de toutes les maladies ». En fait toutes les études et en particulier un rapport du Conseil de l’Ordre des Médecins de 2008, le détaillent : les médecins sont vulnérables, se soignent pas ou mal ; le Burn Out, le taux de suicide, l’alcoolisme sont bien supérieurs à ceux de la population générale. C’est ainsi que l’APSS est née : (Association pour les Soins aux Soignants). Son but est de promouvoir toutes les actions de prévention en matière de pathologie psychique et addictive depuis l’Université, instaurer une médecine préventive pour tous, mais aussi engager « un contrat thérapeutique » sur le modèle des confrères espagnols. De plus, le patient entretient une vision de la santé idéalisée où le droit à la guérison absolue serait un devoir imposé aux soignants et la maladie en particulier chronique puis la mort un échec ! Nous allons donc mettre en évidence les facteurs de risque, mais surtout de protection que dès le début des études le médecin devra essayer de développer, et expliquer le système de solidarité inter-générationnelle proposé par l’Ordre des médecins.
Low bone mineral density (BMD) is a major public health issue leading to fractures, pain and disability. The association between psychosis and low bone density has been suggested in the last years.
The authors review the literature in Medline database using the words ‘bone mineral density’, ‘psychosis’, ‘antipsychotic’, ‘schizophrenia’, ‘bipolar disorder’ and ‘psychiatry disorders’.
Some studies show elevated prevalence of changes in BMD in patients with psychiatry disorders, namely psychosis. These changes are multifactorial, due to therapeutic factors and/or to the disorder per se. The low BMD induced by some antipsychotic drugs has been attributed mostly to hyperprolactinaemia and its consequences. Lithium, carbamazepine, sodium valproate and the use of thyroid-stimulating hormone-suppressive doses of L-thyroxin used in bipolar disorder also have a negative impact on bone health. Patients with psychosis could be vulnerable to bone abnormalities even without treatment, environmental factors like smoking, sedentary lifestyle, decreased exposure to sunlight, alcoholism, dietary deficiencies and polydipsia are partially responsible for that. Also genetic factors (vitamin D receptor gene, estrogen receptor gene etc.) and biological factors (gender, decreased of peak bone mass, abnormalities in immune-inflammatory mechanisms, hypercortisolemia stress-induced etc.) contribute to the abnormalities in bone dynamics in psychosis.
The association between low BMD and psychosis has been demonstrated in literature, understanding all the factors involved in this process will help the development of preventive and treatment strategies. A large study including first psychotic episode patients could be useful to distinguish between disorder and drug induced factors of low BMD in psychosis.
In Europe, in the late 19th century and the first half of the 20th century, new nosologic categories were formulated that could not be framed within Manic-Depressive Psycosis or Kraeplins' Demencia Praecox: Bouffée delirante by the French, Cycloid Psychosis by the German, Reactive and Schizophreniform Psychosis by the Scandinavians. These are concepts that are currently classified in the ICD-10 under Acute and Transitory Psychotic Disorders.
Cycloid Psychosis are characterized by an abrupt onset and polimorfic symptomatology namely delusions, hallucinations in every sensory modality, confusion, akinesia or hyperkinesia, feelings of ecstasy, which can vary with time. They have a recurring course, rapid remission followed by the reinstatement of the premorbid personality.
We present a case study of a female, 26 year old patient. The first psychotic episode occurred 2 years ago and was followed by complete recovery. Recently, there was a recrudescence of the symptomatology. She presented with a polimorfic symptoms, alternating between mutism and psychomotor agitation, disorientation, incoherent speech and almost total insomnia. There was an absence of response to antipsychotic medication. Therefore, the patient was submitted to electroconvulsive therapy with an overall improvement of symptoms, maintaining some puerility. The aim of this case study was to draw attention to the diagnosis of Cycloid Psychosis, and it confirms the efficacy of electroconvulsive therapy in its treatment.
Soldiers in combat situations need to learn to quickly identify and respond to threatening stimuli, but once safe home this learning has to be ignored. PTSD patients might be impaired in their ability to learn that cues that predicted danger in the context of war do not predict danger in a new context. A leading model for studying fear learning is Pavlovian fear conditioning, in which an emotionally neutral conditioned stimulus (CS) is paired with an aversive unconditioned stimulus (US). Following acquisition of fear response, fear extinction can be achieved by presenting the CS without the US. While fear acquisition and extinction partially model the fear modulation processes, a paradigm, which is much more interesting in the context of PTSD, is the reversal of aversive reinforcement contingencies. In this case, after acquisition of fear to one CS, the fear response is not eliminated but rather is switched to another CS. While extinction learning can only identify a diminished ability to extinguish the conditioned response in PTSD patients compared to healthy controls, reversal learning will allow us to test three distinct predictions: 1) PTSD patients may be more sensitive to fear learning compared to healthy controls; 2) PTSD patients may have difficulties in unlearning a fear response; 3) PTSD patients may generalize the fear response they developed for the first CS. We contrasted fMRI and GSR data collected during the reversal task from soldiers who developed PTSD with those of combat exposed soldiers without PTSD, as well as with healthy controls.
Ménière's disease is a debilitating chronic peripheral vestibular disorder associated with psychiatric co-morbidities, notably depression.
Database searches were performed to identify studies that assessed depression in Ménière's disease. Metrics used to diagnose depression were extracted, along with the prevalence of depression in each study.
Fifteen studies from 8 different countries reported on 6587 patients. The weighted average age was 55.3 years (range, 21–88 years). Depression was measured by eight different scales, with Zung's Self-Rating Depression Scale used most often. A weighted proportion of 45.9 per cent of patients (confidence interval = 28.9–63.3) were depressed. Weighted averages (± standard deviations) of Beck's Depression Inventory and the Illness Behavior Questionnaire – Dysphoria were 8.5 ± 7.9 and 2.4 ± 1.7, respectively.
The prevalence of depression in patients with Ménière's disease is nearly 50 per cent. Treating otolaryngologists should have a low threshold to screen and refer appropriately. Identifying and treating depression should allow for improvement of overall quality of life in patients with Ménière's disease.