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Disulfiram is an aversive medication that works by making the drinking of alcohol an unpleasant experience (FDA approved since 1951) and most study of understanding alcohol abuse and dependence are based on it. Also, the combined Cognitive Behavioral Therapy (CBT) and disulfiram assurance treatment was substantially effective in patients with alcohol disorders.
We conducted 150 male patients range of age 20-60 and treated in Special Hospital on Addictions for 3 months period of time (inpatient setting).The recommended dose of disulfiram was 250 mg. All patients were diagnosis of alcohol dependence according the ICD-X, excluded psychosis and no one was unable to take disulfiram for medical reason. We used medical history of illness, psychiatric interview and semi structured CBT protocol for alcohol disorder and CBT sessions (2 sessions per week). Control group were 80 patients on disulfiram assurance therapy (alone).
CBT plus disulfiram assurance (N=150): 93(62%) maintaining sobriety and absence of drinking for 3 months; 44 (29,33%) maintaining sobriety for 2 months and 13 (8,66%) absence of drinking only 1 - 1,5 month.Disulfiram assurance therapy alone (control group) (N=80): 41 (51,25%) maintaining sobriety of drinking for 3 months; 22 (27,5%) less than 3 months; 10 (12,5%) for 1,5 - 2 months and 7 patients (8,75%) drop-out after a week without no relevant or medical reasons.
In this paper was shown the high level of effectiveness for the CBT combined with disulfiram assurance therapy according the maintaining sobriety and absence of drinking.
Present study focuses on metabolic and neuroendocrinologic effects of long-acting injectable risperidone (LAIR) treatment in a naturalistic sample of patients with schizophrenia spectrum disorders.
Twenty three outpatients with schizophrenia or schizoaffective disorder (ICD X) (age 32.3±6.5years, illness duration 8.7±5.1 years, PANSS 78.1±14.7) were included. At the time of evaluation the patients were treated with LAIR for 1.4±0.7 years, average dose 38.6±9.9mg. Total duration of antipsychotic therapy was 8.0±4.8 years. Control group (n=23) were healthy volunteers matched by age, sex and education.In the morning serum we measured leptin, prolactin, cortizol, IGF1, T4, FSH, LH, HbA1c, total cholesterol, HDL, LDL and triglicerides. Both groups were tested by oral glucose load (OGTT), with measuring insulin levels and anthropometric parameters.
In comparison to control group, the patients had higher BMI (p< .001), waist circumference (WC, p=.004), increased leptin (p=.013), prolactin (p< .001), triglycerides (p=.029) and fasting glucose (p=.004). After controlling for BMI, WC and sex, only prolactin (p< .001, ηp2= .50) and leptin (p=.040, ηp2=.13) were significantly increased in the patient group.
This is the first study of LRAI effects on metabolic and neuroendocrine parameters. Our cross-sectional study has shown that the most consistent side effects of LAIR were increased prolactin and leptin, while other deviations might be attributed to confounding covariates. Whether pharmacokinetic and pharmacodynamic advantages of LAIR over oral drug formulation are accompanied with favorable metabolic and neuroendocrine profile remains to be assessed by head to head studies.
This study was supported by a grant from the Ministry of Science, Republic of Serbia (Project 145019).
Traumatic brain injury (TBI) is recently recognized as a risk factor for hypopituitarism, presented most frequently with growth hormone deficiency (GHD). GHD is associated not only with changes in body composition, but also with impaired quality of life, cognitive dysfunctions and some psychiatric sequelae, usually classified as “depression” or “atypical depression”. The impact of GH therapy on mental status is still unknown.
Psychiatric and cognitive functions were tested in six adult GHD subjects at baseline (minimum three years after TBI), reassessed after six months of GH replacement therapy as well as twelve months after discontinuation of GH therapy. Psychiatric and cognitive examinations included semi-structured interviews and three instruments: Symptom-checklist (SCL-90-R), Zung Depression Inventory and standard composite neuropsychological battery.
Six months of GH therapy in GHD TBI patients improved cognitive abilities (particularly verbal and nonverbal memory) and improved psychiatric functioning. Severity of depression decreased, as well as intensity of interpersonal sensitivity, hostility, paranoid ideation, anxiety and psychoticism. In three GHD patients who stopped GH therapy for twelve months we registered worsening of the verbal and nonverbal memory, as well as increase in Zung score and three SCL dimensions: inter-personal sensitivity, anxiety and paranoid ideation.
This preliminary data suggest that GH therapy induced reduction of depression, social dysfunction and improvement in certain cognitive domains in GHD patients after TBI. Our data support the necessity of conducting randomized placebo-controlled trials on the effects of GH therapy on neuropsychological and psychiatric status in GHD TBI patients.
It has been shown that abusive experiences in childhood may be related to specific behavior patterns manifested in adulthood, especially those that refer to negative parenting practices. The aim of this study was to assess the relationship between the use of punitive parental discipline and the childhood abuse trauma in parents.
Sixty six parents (30 males, 36 females, age 45.92±8.79 yrs, predominantly urban) completed the socio-demographic questionnaire, the Childhood Trauma Questionnaire (CTQ), and the punitive discipline self-report measure.
The frequency of use of punitive discipline between parents with and without the history of abuse was not significantly different (t=-1.298; p>0.05). The difference was not found neither among fathers (t=-0.047; p>0.05) nor among mothers (t=-1.951; p>0.05). Emotional abuse was the only type of childhood maltreatment related to the use of punitive discipline (r=0.393; p< 0.01). This relationship was found among both fathers (r=0.428; p< 0.05) and mothers (r=0.371; p< 0.05). In females, the use of punitive discipline was additionally related to the history of emotional neglect (r=0.379; p< 0.05).
The findings may emphasize the need for identification and modification of the parental discipline strategies in adult victims of child emotional abuse and neglect.
The aim of this paper is womens needs assessment in the new organisational concept of psychiatric care-community mental health care, which started with its implementation in Bosnia and Herzegovina in 1996 immediately after the war.
This study is retrospective and analytical-descriptive. As research instrument was used the Questionnaire for womens needs assesment in mental health care, which was designed for the purpose of this study and which has been applied at two groups,homogenious according to gender. Each group was consisted from 50 female patients.
The results of this study indicated the womens needs for inovative forms of community mental health care-the opportunity to choose woman as psychiatrist and women as team members, as well as the opportunity to use separate community mental health services-for women only.
The results of this study, which are in accordance with new womens community mental health care trends in USA and some Western European countries, obviously indicates the womens needs in mental health care. According to the study results, womens needs should be met in the early stage of new psychiatric care concept implementation.In the same time that would present in Bosnia and Herzegovina inovation of community mental health care, and also assure that womens mental health needs would be met at optimal way.
Electroshock therapy is in fashion again, but modern psychiatry for this kind of treating is using up to date instruments and methods. Half a century ago this procedure was used for healing serious depression, but was substituted with pharmacotherapy due to side effects like short or long time lost of memory.
Today we have modern technology (ECT with pulse electricity), so side effects are milder, and effects of therapy are better.
With this work we want to present the latest concepts in use of ECT therapy and to present our modest, one year long experience in this area.
We also started prophylactic ECT therapy (in imitation on Military medical academy Belgrade), since we was forced to accept already started treatment some of our patients in above mentioned institution.
Somatoform Disorders (SD) represent a big clinical challenge regarding frequent medical assistance demand, functional impairment and partial pharmacotherapy response.
The study objective was to ascertain the efficacy and tolerability of pregabalin (PG) in patients with SD and patients with comorbid diagnoses as follows: F41.1, F32, F33 or F34 and F45 with partial response to antidepressant therapy (SSRI, SNRI, MAOI, TCAs, SARIs, SNDIs) after long-term treatment.
This was prospective, nine months, open-label study. The sample consisted of 31 patients with SD diagnosed as F45 according to ICD-10 criteria by standard clinical interview. The assessment was made by the following instruments: 100 mm visual analogue scale (VAS) which assessed physical symptom severity and Clinical Global Impression Scale (CGI). The baseline assessment was done, while follow up was made after seventh day, one, two and nine months. Patients were treated with PG (dose ranged from 150 to 300 mg per day), as monotherapy or in combination with antidepressant and/or benzodiazepines (BZD) which were previously taken.
At the end of the study 18 patients (58.06%) self-rated their severity as no pain, while 8 (25.81%) rated as mild pain using VAS. After nine months 26 patients (83.87%) showed an overall improvement (CGI). Five patients (16.13%) had side effects (feeling of dizziness in initial PG treatment phase), which was the reason for the PG discontinuation in three patients (9.67%).
High efficiency, absence of serious side effects and good tolerability of pregabalin opens a new opportunity for the successful treatment of patients with SD.
Patient G. D. born in 1975, trained as a textile worker, unemployed, married, mother of three children. The current hospitalization was due to suicide attempts and manifestation of depressive symptoms after a stressful event.
Our diagnostic dilemma was whether it concerns:
- depressive disorder with psychotic symptoms
- adjustment disorder in people with personality disorder
After applying diagnostic procedures and observations during individual psychotherapy sessions, as well as the response to a given therapy, psychotic depression is excluded. The stories provided from the patient were in conflict since they have changed in contact with different therapists in the same department, why we decided to consult other professionals from other departments at which the patient apparently was treated.
In this disorder the patient is aware that he is exaggerating and faking illness, but in core of the disease is irresistible urge for pointing attention, and the cause is most likely a lack of love and affection in childhood.
In psychoterapic process was included family therapist also. Family therapist confronted patient with family members, which resulted in a real insight into the mental state and allowed us to confirm a diagnose of histionic personality disorder with tendency to pathological lying- Munchausen syndrome.
In this presentation, we wanted to point out the necessity of cooperation of a psychiatrist with other specialists, considering that patients with this disorder are prone to change therapists, hospitals and faking the results of diagnostic tests.
Somatoform disorders (SD) are an example of the complex interaction between mind and body.
To estimate the efficacy of pregabalin (PG) versus combination of pregabalin and antidepressants in patients with SD who were previously on long-term treatment with at least three antidepressants (SSRI, SNRI, SARIs, SNDIs, MAOI, TCAs) in an adequate therapeutic dose and had a partial response on it. In this open label trial investigators diagnosed 41 patients by standard clinical interview as F 45.0 and F 45.4 according to ICD-10 criteria and divided them in two groups: experimental (Pregabalin, 20 patients) and control group (Pregabalin + antidepressant, 21 patients). Patients also had comorbid diagnoses as follows: F 41.1, F 32, F 33 or F 34. Assessment was done by 100 mm Visual analogue scale (VAS) and by Clinical Global Impression Scale (CGI). Within both groups there was a statistically significant improvement measured by VAS and CGI scales in all repeated measurements, except for the CGI scale in both groups between the second and ninth month where there was no statistical difference. There were no statistically significant differences between CG and EG on both scales either in the beginning or in repeated measurements. There was no difference in the effects of the drugs between EG and CG on both scales- VAS & CGI. Pregabalin as mono or as an adjuvant therapy had equally good efficiency in patients with SD who had partial response on various antidepressants therapy after long-term treatment.
Disclosure of interest
Results from part of this trial were published as abstract in european psychiatry, Volume 30. Supplement 1, 28–31 March 2015, Pages 534 – “Somatoform Disorders-a New Target for Pregabalin”, http://dx.doi.org/10.1016/S0924-9338(15)30418-1.
Severe side effects of chemotherapy during treatment of malignant disease significantly disrupt patient's mental and physical state. Seventy five-years-old female patient was treated for breast cancer by protocol (operation, radiotherapy, chemotherapy-paclitaxel (CHT-PX) every tree weeks) and for dysthymia and generalized anxiety disorder with escitalopram (ESC). Tramadol (TRA) and clonazepam (KLO) given by oncologist due to severe side effects of CHT-PX: muscle cramps, lower back pain, walking difficulties, had partial results, increased anxiety and drug abuse (TRA doses increase from 100 to 300 mg/day and KLO from 4 to 6 mg/day). Efficiency of pregabalin (PG) in pain and anxiety control during CHT-PX application. The assessment was made by 100 mm visual analogue scale (VAS), which assessed physical symptom severity and Hamilton Anxiety Rating Scale (HAMA) on the first day after CHT-PX application, on the 7th, 14th and 21th day. Effective PG dose was 300 mg/day with EST, KLO and TRA previously taken. On the first day after CHT-PX, patient rated pain level as 9 according to VAS. During TRA and KLO treatment, pain level on VAS was 6 from the 7th till 14th day after CHT-PX, on 21th day deceased to 2. HAMA score was 49. After PG augmentation, according to VAS, pain level was 3 on the 7th day and 0 on 14th day. HAMA score was 20. Tapering off the dose of TRA and KLO started till discontinuation of both medications. Pregabalin efficiency in pain and anxiety control increase compliance of oncological patient and reduce harm of drug abuse.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Insurance industry practitioners have deep knowledge of their industry, but there is a lack of a simple-to-understand, practical blueprint on applying distributed ledger technology solutions, including blockchain. This paper provides a practical guide for actuaries, risk professionals, insurance companies and their Boards on blockchain, including an education piece to provide an understanding of the technology. Examples of real-world applications and use cases in insurance are provided to illustrate the capability of the technology. The current risks and challenges in adopting the technology are also considered. Finally, a checklist of issues to consider in adopting a blockchain solution for insurance business problems is provided.
Maternal mental disorders have been associated with the risk of attention-deficit/hyperactivity disorder (ADHD) in children. Within the context of a mother–child cohort, we examined whether maternal anxiety, depression and sleep disorders are associated with pre-school ADHD symptoms.
The study included 3634 singletons from the Italian NINFEA (Nascita e INFanzia: gli Effetti dell'Ambiente’) cohort. Maternal doctor-diagnosed anxiety, depression and sleep disorders before and during pregnancy were assessed from the questionnaires completed during pregnancy and 6 months after delivery. Mothers rated child ADHD symptoms at 4 years of age, according to the Diagnostic and Statistical Manual of Mental Disorders. Hyperactive–impulsive (ADHD-H), inattentive (ADHD-I) and total ADHD scores were analysed in the models adjusted for child's gender, first-born status, maternal age, education, alcohol consumption and smoking during pregnancy.
The total ADHD score at age 4 was associated with maternal lifetime anxiety (17.1% percentage difference in score compared with never; 95% CI 7.3–27.9%), sleep disorders (35.7%; 95% CI 10.7–66.5%) and depression (17.5%; 95% CI 3.2–33.8%). Similar positive associations were observed also for ADHD-H and ADHD-I traits, with slightly attenuated associations between maternal sleep disorders and child ADHD-I score, and maternal depression and both ADHD scores. All the estimates were enhanced when the disorders were active during pregnancy and attenuated for disorders active only during the pre-pregnancy period.
Maternal anxiety, depression and sleep disorders are associated with a relative increase in the number of ADHD-H, ADHD-I and total ADHD symptoms in preschoolers.
The Working Party has produced this report in order to prompt readers to engage at an early stage in InsurTech projects, through considering (i) the full range of risks associated with InsurTech developments, (ii) the lifecycle of an InsurTech venture and how any risk considerations may vary over this lifecycle and (iii) the extent to which InsurTech ventures align with risk strategy and risk appetite.
The report contains practical guidance for actuaries, risk professionals, insurance companies and their Boards on these considerations, and can be used to facilitate appropriate questioning, to help ensure that InsurTech-related business decisions are fully cognisant of the risk management issues and to help ensure the success of projects.
The Working Party developed this guidance having carried out an industry survey on a number of risk management topics relating to InsurTech, as well as having carried out interviews with a number of relevant senior stakeholders across the insurance industry, in order to better understand current sentiment and how risk management plays a part when considering opportunities in InsurTech. The Working Party views on the findings from these activities are summarised in the report.
Three-dimensional temporal instabilities, leading to spray formation of a round liquid jet segment with an outer, coaxial high-density gas flow, are studied with Navier–Stokes and level-set computations. These computations predict the liquid surface shape showing the smaller structures on the conical wave crests, i.e. lobes, holes, bridges and ligaments, which are the precursors to droplet and spray formations. These structures and their time scales affect droplet size and velocity distributions as well as spray cone angles. The gas-to-liquid density ratio, liquid Reynolds number (
) and liquid Weber number (
) range between 0.02–0.9, 320–16 000 and 2000–230 000, respectively, which cover three distinct physical domains. (1) At higher
, ligaments and then drops develop following hole and liquid bridge formations. (2) At higher gas densities throughout the
range, several holes merge forming two bridges per lobe before breaking to form ligaments; this hole merging is explained by slower development of hairpin vortices and lobe shape. (3) In cases where both gas density and
are lower, the well-ordered lobes are replaced by more irregular, smaller-scale corrugations along the conical wave crest edge; ligaments form differently by stretching from the lobes before holes form. Thicker ligaments and larger droplets form in the low
, low gas density range. The surface wave dynamics, vortex dynamics and their interactions are explained. Understandings of liquid stream break up and concurrent smaller structure formation are built upon an examination of both translation and rotation of the fluid. In all cases, hole formation is correlated with hairpin and helical vortices; fluid motion through a perforation in the thin sheet near the wave crest corresponds to these vortices. The hole formation process is dominated by inertial forces rather than capillary action, which differs from mechanisms suggested previously for other configurations. Circulation due to streamwise vorticity increases while the lobes thin and holes form. For larger surface tension, cavities in the jet core rather than perforations in a sheet occur. The more rapid radial extension of the two-phase mixture with increasing gas density is explained by greater circulation in the ring (i.e. wave crest) region. Experimental descriptions of the smaller structures are available only at lower
and lower density, agreeing with the computations. Computed scales of bridges, ligaments, early droplets and emerging spray radii agree qualitatively with experimental evidence through the high
Spices, herbs and medicinal plants as a feed supplements present promising alternatives to antibiotic growth promoters due to their high content of bioactive substances. A large number of experiments have confirmed a wide range of activities of spices in poultry nutrition such as stimulation of feed intake, antimicrobial, antioxidative and coccidiostat stimulation, increase of body weight gain, lowering the mortality rate and improvement of the blood and tissue lipid profile. The present paper gives a review on the characteristics of hot red pepper and its mode of action in broilers nutrition.
The aim of this review paper is to show the most important bioactive compounds of garlic (Allium sativum L.), modes of action of garlic powder and its effects on broiler chicken productive performance. Allicin is thought to be the principal bioactive compound present in aqueous garlic extract or raw garlic homogenate. When garlic is chopped or crushed, the allinase enzyme present in garlic is activated and acts on alliin to produce allicin. Other important sulphur containing compounds present in garlic are allyl methyl thiosulphonate, 1-propenyl allyl thiosulphonate and γ-L-glutamyl-S-alkyl-L-cysteine. These active compounds are thought to influence feed consumption, feed utilisation, body weight, blood lipid profiles and cholesterol levels in chickens. Biological responses to these bioactive compounds have been attributed to a reduction in risk factors for cardiovascular diseases and cancer, stimulation of immune function, enhanced detoxification of foreign compound, hepatoprotection, antimicrobial, antifungal, anti-inflammatory and antioxidant effects.
We propose that observations of ‘hidden’ magnetars in central compact objects can be used to probe crustal activity of neutron stars with large internal magnetic fields. Estimates based on calculations by Perna & Pons, Pons & Rea and Kaminker et al. suggest that central compact objects, which are proposed to be ‘hidden’ magnetars, must demonstrate flux variations on the time scale of months–years. However, the most prominent candidate for the ‘hidden’ magnetars — CXO J1852.6+0040 in Kes 79 — shows constant (within error bars) flux. This can be interpreted by lower variable crustal activity than in typical magnetars. Alternatively, CXO J1852.6+0040 can be in a high state of variable activity during the whole period of observations. Then we consider the source 1E161348 − 5055 in RCW103 as another candidate. Employing a simple 2D-modelling we argue that properties of the source can be explained by the crustal activity of the magnetar type. Thus, this object may be supplemented for the three known candidates for the ‘hidden’ magnetars among central compact objects discussed in literature.