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Reward Deficiency Syndrome (RDS) is an umbrella term for all drug and nondrug addictive behaviors, due to a dopamine deficiency, “hypodopaminergia.” There is an opioid-overdose epidemic in the USA, which may result in or worsen RDS. A paradigm shift is needed to combat a system that is not working. This shift involves the recognition of dopamine homeostasis as the ultimate treatment of RDS via precision, genetically guided KB220 variants, called Precision Behavioral Management (PBM). Recognition of RDS as an endophenotype and an umbrella term in the future DSM 6, following the Research Domain Criteria (RDoC), would assist in shifting this paradigm.
Diet has a major influence on the composition and metabolic output of the gut microbiome. Higher-protein diets are often recommended for older consumers; however, the effect of high-protein diets on the gut microbiota and faecal volatile organic compounds (VOC) of elderly participants is unknown. The purpose of the study was to establish if the faecal microbiota composition and VOC in older men are different after a diet containing the recommended dietary intake (RDA) of protein compared with a diet containing twice the RDA (2RDA). Healthy males (74⋅2 (sd 3⋅6) years; n 28) were randomised to consume the RDA of protein (0⋅8 g protein/kg body weight per d) or 2RDA, for 10 weeks. Dietary protein was provided via whole foods rather than supplementation or fortification. The diets were matched for dietary fibre from fruit and vegetables. Faecal samples were collected pre- and post-intervention for microbiota profiling by 16S ribosomal RNA amplicon sequencing and VOC analysis by head space/solid-phase microextraction/GC-MS. After correcting for multiple comparisons, no significant differences in the abundance of faecal microbiota or VOC associated with protein fermentation were evident between the RDA and 2RDA diets. Therefore, in the present study, a twofold difference in dietary protein intake did not alter gut microbiota or VOC indicative of altered protein fermentation.
Topiramate is an antiepileptic agent, which is being investigated as a mood-stabilizer. Three obese individuals with DSM-IV bipolar I disorder and type II diabetes mellitus received topiramate treatment in combination with antipsychotics and valproate or carbamazepine. In addition to improved mood stability, these individuals lost between 16 to 20.5% of their pre-topiramate body weight and also achieved significant glycemic control.
Culture-bound syndromes are defined as 'episodic and dramatic reactions specific to a particular community'. 'Dhat' syndrome or 'loss of semen' leading to weakness, is a culture bound sex neurosis in the Indian subcontinent not common in rest of the world.
Aims and Objective:
To highlight how Culture Bound Syndromes can transcend geographical boundaries.
A detailed history of the presenting complaints, past and family history and use of ICD 10 (WHO) for diagnosis/excluding other major mental illness.
15 year old unmarried, Afghani male whose family migrated to Australia before his birth (never went back to Afghanistan), presented with anxiety, difficulty in falling asleep, poor appetite, and weakness for 6 months. His symptoms started after being introduced to pornographic films by friends. He began masturbating 3-4 times everyday which soon became a concern to him, believing it to be 'excessive and harmful' (masturbatory guilt). For the next 3 months, he tried to abstain from masturbation, leading to problems like passage of 'whitish' discharge in urine (?precome) and nocturnal emissions, leading to more anxiety and low mood. He did not fulfil ICD 10 criteria for depression.
Fluoxetine 20 mgs daily was started with sexual counselling,(psycho education about masturbation). He showed improvement within 6 weeks and at follow-up 6 months showed complete resolution.
'Dhat Syndrome' a Culture Bound Syndrome, not normally reported in Modern Western world may still present in 2nd generation immigrants, with no overt contact with their original culture, possibly due to deep rooted trans-generational cultural ties.
Trichotillomania is a psychiatric disorder characterized by an urge to pull out hair from the scalp or other parts of the body (Impulse Control Disorder) relatively uncommon in children.
The following two clinical vignette highlight varying presentation of trichotillomania in children from two differing age groups (>6 yrs and <12 yrs)
To showcase 2 cases of trichotillomania with differing co-morbidities.
ICD 10 (WHO) was the primary diagnostic tool used here. MGH Hair Pulling Scale was used for rating the severity of Trichotillomania. As both patients had suspected mental sub normality, WISC was used for IQ assessment.
Case 1: Trichotillomania with OCD and ?Secondary depression with MR
14 year old female, presented with compulsive eyebrow pulling for 1 year. For last 6 months showing OCD and depressive symptoms. She scored 32 on YBOCS with main obsession – excessive concerns with germs and main compulsions - excessive or ritualized hygiene. On MGH hair Pulling scale she scored 21. Her IQ score was 65, suggesting Mild Intellectual Disability.
Case 2: Trichotillomania with Pica and MR
5 year old female, presented with compulsive hair pulling and ingesting it (Trichophagia) for 18 months. Also eating non edible things like soil and paper (Pica). No major physical illness found. On MGH Hair Pulling Scale, she scored 17. X-ray of GIT showed no Trichobezoar (hair ball). Her IQ was 60, (Mild Intellectual Disability).
The study illustrates how trichotillomania can be a part of a more complex psychiatric presentation with co-morbidities
Recent decades, has seen an increasing focus on developing specific early or first episode psychosis services, in various parts of the world. There has been a growing awareness of the emotional impact of psychosis like trauma at onset, suicide and loss of social network. There is also a co relational link between the duration of untreated psychosis (DUP) and outcomes. The first 2–3 years following first episode onset have been argued to be a critical period for treatment.
Our study was an evaluation of an early psychosis service (EPS) in a rural Australian MHS ‘experiencing’ or ‘at risk’ of experiencing first episode psychosis. The guidelines were based on the Australian clinical guidelines for early psychosis (1998). The audit tool used was a checklist based on 10 treatment guidelines developed by the EPS special interest group evaluation sub-committee.
The overall results show that 7 out of the 10 treatment guidelines were well adhered throughout the implementation process. Guidelines strongly adhered to were numbers 2, 3, 5, 6, 7, 8, and 10, whereas guidelines 1, 4, and 9 were poorly adhered to.
The implementation process was found to be generally effective. The factors that influenced the effectiveness will be discussed in the poster.
There were a number of trends when we looked at the overall results which included aspects of the guidelines that were done well and aspects that needed improvement which will be further discussed in the poster.
Disclosure of interest
The author has not supplied his/her declaration of competing interest.
Case presentation of a young woman Ms. SH, with neuropsychiatric presentation in a rare Lysosomal Storage Disorder (Fabry's disease).
A 19-year-old female with Fabry's disease (FD) presented initially with symptoms of obsessions of dirt and contamination and compulsions of washing and also with overvalued persecutory ideas of being followed. Since the age of 14, she had suffered from various psychiatric symptoms increasing in frequency and intensity. Routine examinations including cognitive testing, electroencephalography and structural magnetic resonance imaging revealed no pathological findings. During the course of a year, her OC symptoms improved significantly with the use of Fluoxetine 40 mg mane. However, she then became more depressed and psychotic (despite continuing on Fluoxetine). Addition of Risperidone (gradually increased to 2 mg nocte) led to attenuation of her symptoms and she recovered completely over a course of another 6 months.
Mental and behavioural symptoms in Fabry Disease symptoms usually begin during late childhood or adolescence but may not become apparent until the second or third decade of life. Early symptoms include episodes of severe burning pain in the hands and feet and skin lesions. The psychiatric manifestations can be varied, e.g. the index patient, initially presented with what appeared like an Obsessive Compulsive disorder but later as a depressive illness (Muller et al,. 2006) with psychotic symptoms.
To showcase mental and behavioural symptoms associated with a rare disorder like Fabry's disorder and treatment options may be helpful.
Disclosure of interest
The author has not supplied his declaration of competing interest.
Case presentation of a middle aged lady Mrs. C.K., who developed tardive dyskinesia (TD) after a trial of an SSRI.
A 49-year-old Australian aboriginal lady, presented with involuntary movement of her face (bucco-linguo masticatory), movements after a 3 months trial of sertraline (maximum dose of 100 mg daily) for her depressive illness. There was no history of trials with anti-psychotics or any other medications, which may have caused the oral dyskinesias. Routine examinations including cognitive testing, EEG and MRI revealed no pathological findings. Her sertraline was ceased and she was commenced on mirtazapine 15 mg at night, which was hiked to 30 mg after 1 week and continued on this dose over the next 3 months. She exhibited good improvement in her depressive symptoms and a significant attenuation of her TD's. Involuntary movement scale rating: she was rated on the abnormal involuntary movement scale (AIMS) and showed gradual improvement in the severity of her orofacial dyskinetic movement. Her scores were–initial presentation (scored 22/36); at 4 weeks (9/36); 8 weeks (6/36) and at 16 weeks (4/36).
Although TD's are seen in approximately 1 to 5% of mental health patients treated with anti-psychotics (and some other medications like Levodopa, Metochlorpromide, etc.), research studies on SSRI's causing TD's are rare and few (Leo et al., 1996; Gerber et al., 1998).
To alert and educate clinicians about a relatively rare adverse-effect of SSRI producing an involuntary movement disorder.
Disclosure of interest
The author has not supplied his/her declaration of competing interest.
Case presentation of a young woman Ms. A.M., referred by her GP with an eating disorder, who was thereafter diagnosed with an uncommon type of phobia (emetophobia – a specific phobia of vomiting) and treated accordingly.
To highlight the diagnostic dilemma with such uncommon cases, who are often misdiagnosed as having anorexia nervosa or bulimia nervosa or suffering from other anxiety disorders (like OCD or GAD).
A comprehensive mental state examination was conducted including a diagnostic clarification interview. She was followed up by the mental health team on a regular basis with support and also providing appropriate psychotherapy.
Ms. A.M. refused medications and only agreed to non-pharmacological treatment. She was therefore commenced on once weekly psychotherapy (CBT), which she undertook for a period of 4 months. She showed good response to the psychotherapy with significant attenuation of her core symptoms, although she still continued to exhibit some avoidance behaviors.
This particular patient showcases a relatively uncommon and often misdiagnosed specific phobia (emetophobia) and highlights the positive response seen in this case with psychotherapy.
Disclosure of interest
The author has not supplied his declaration of competing interest.
Tomasello argues that humans’ sense of moral obligation emerges early in development, relies on a shared “we,” and serves as the foundation of cooperation. This perspective complements our theoretical view of the human self as information agent. The shared “we” promotes not only proximal cooperative goals but also distal ones via the construction of shared understanding – it promotes culture.
Comparison of bacterial counts (BCs) among common bedding types used for dairy cows, including straw, is needed. There is concern that the microbial content of organic bedding is elevated and presents risks for dairy cow udder health and milk quality. The objectives of this study were to investigate: (1) % DM and BCs (Streptococcus spp., all gram-negatives and specifically Klebsiella spp.) in different types of bedding sampled, and to investigate housing and farm management factors associated with % DM and BCs; (2) if bedding type was associated with hygiene of cow body parts (lower-legs, udder, upper-legs and flank) and housing and management factors associated with hygiene and (3) bedding types associated with higher BCs in cow milk at the farm level and bulk tank milk and management factors that were associated with highest BCs. Seventy farms (44 free-stall and 26 tie-stall) in Ontario, Canada were visited 3 times, 7 days apart from October 2014 to February 2015. At each visit, composite samples of unused and used bedding were collected for % DM determination and bacterial culture. Used bedding samples were collected from the back third of selected stalls. Data were analyzed using multivariable linear mixed models. Bedding classification for each farm were: new sand (n = 12), straw and other dry forage (n = 33), wood products (shavings, sawdust; n = 17) and recycled manure solids (RMSs)-compost, digestate (n = 8). In used bedding, across all bedding samples, sand was driest, compared to straw and wood, and RMS; higher % DM was associated with lower Streptococcus spp. count. Streptococcus spp. and all Gram-negative bacteria counts increased with increasing days since additional bedding was added. Gram-negative bacteria counts in used bedding varied with type: RMS = 16.3 ln colony-forming units (cfu)/mL, straw = 13.8 ln cfu/mL, new sand = 13.5 ln cfu/mL, and wood = 10.3 ln cfu/mL. Klebsiella spp. counts in used bedding were lower for wood products (5.9 ln cfu/mL) compared to all other bedding types. Mean cow SCC tended to be higher on farms with narrower stalls. Farms with mattress-based stalls had a higher prevalence of cows with dirty udders compared to those using a deep bedding system (often inorganic sand). Wider stalls were associated with lower bulk milk bacteria count. Lower % DM of used bedding was associated with higher bulk milk bacteria count. In conclusion, bedding management may have a profound impact on milk quality, bacterial concentrations in the bedding substrates, and cow hygiene.
Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9.
We conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy.
16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (−0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01).
PHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.
Different diagnostic interviews are used as reference standards for major depression classification in research. Semi-structured interviews involve clinical judgement, whereas fully structured interviews are completely scripted. The Mini International Neuropsychiatric Interview (MINI), a brief fully structured interview, is also sometimes used. It is not known whether interview method is associated with probability of major depression classification.
To evaluate the association between interview method and odds of major depression classification, controlling for depressive symptom scores and participant characteristics.
Data collected for an individual participant data meta-analysis of Patient Health Questionnaire-9 (PHQ-9) diagnostic accuracy were analysed and binomial generalised linear mixed models were fit.
A total of 17 158 participants (2287 with major depression) from 57 primary studies were analysed. Among fully structured interviews, odds of major depression were higher for the MINI compared with the Composite International Diagnostic Interview (CIDI) (odds ratio (OR) = 2.10; 95% CI = 1.15–3.87). Compared with semi-structured interviews, fully structured interviews (MINI excluded) were non-significantly more likely to classify participants with low-level depressive symptoms (PHQ-9 scores ≤6) as having major depression (OR = 3.13; 95% CI = 0.98–10.00), similarly likely for moderate-level symptoms (PHQ-9 scores 7–15) (OR = 0.96; 95% CI = 0.56–1.66) and significantly less likely for high-level symptoms (PHQ-9 scores ≥16) (OR = 0.50; 95% CI = 0.26–0.97).
The MINI may identify more people as depressed than the CIDI, and semi-structured and fully structured interviews may not be interchangeable methods, but these results should be replicated.
Declaration of interest
Drs Jetté and Patten declare that they received a grant, outside the submitted work, from the Hotchkiss Brain Institute, which was jointly funded by the Institute and Pfizer. Pfizer was the original sponsor of the development of the PHQ-9, which is now in the public domain. Dr Chan is a steering committee member or consultant of Astra Zeneca, Bayer, Lilly, MSD and Pfizer. She has received sponsorships and honorarium for giving lectures and providing consultancy and her affiliated institution has received research grants from these companies. Dr Hegerl declares that within the past 3 years, he was an advisory board member for Lundbeck, Servier and Otsuka Pharma; a consultant for Bayer Pharma; and a speaker for Medice Arzneimittel, Novartis, and Roche Pharma, all outside the submitted work. Dr Inagaki declares that he has received grants from Novartis Pharma, lecture fees from Pfizer, Mochida, Shionogi, Sumitomo Dainippon Pharma, Daiichi-Sankyo, Meiji Seika and Takeda, and royalties from Nippon Hyoron Sha, Nanzando, Seiwa Shoten, Igaku-shoin and Technomics, all outside of the submitted work. Dr Yamada reports personal fees from Meiji Seika Pharma Co., Ltd., MSD K.K., Asahi Kasei Pharma Corporation, Seishin Shobo, Seiwa Shoten Co., Ltd., Igaku-shoin Ltd., Chugai Igakusha and Sentan Igakusha, all outside the submitted work. All other authors declare no competing interests. No funder had any role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.
The ~492 Ma Shetland Ophiolite Complex contains an extensive mantle section, within which numerous podiform chromitite bodies formed during melt percolation in a supra-subduction zone setting. One of the Shetland ophiolite chromitite localities has an unusual style of platinum-group element (PGE) mineralization. Specifically, the Cliff chromitite suite has relatively high (>250 ppm) Pt plus Pd, compared to other chromitites in the Shetland Ophiolite Complex. In this study, we apply petrographic observation, mineral chemistry and novel X-ray microtomography data to elucidate the petrogenesis of PGE-bearing phases at Cliff. The combined datasets reveal that the PGE at Cliff have probably been fractionated by an As-rich fluid, concentrating Pt and Ir into visible (0.1–1 µm) platinum-group minerals (PGM) such as sperrylite and irarsite, respectively. The high (>1 ppm) bulk-rock concentrations of the other PGE (e.g. Os) in the Cliff chromitites suggests the presence of abundant fine-grained unidentified PGM in the serpentinized groundmass. The spatial association of arsenide phases and PGM with alteration rims on Cr-spinel grains suggests that the high Pt and Pd abundances at Cliff result from a late-stage low-temperature (e.g. 200–300°C) hydrothermal event. This conclusion highlights the potential effects that secondary alteration processes can have on modifying and upgrading the tenor of PGE deposits.
Secondary carbonate deposits (similar to speleothems) in urban undergrounds, have been recently highlighted as powerful archives for reconstruction of the historical anthropogenic imprint on the environment. The precise chronology of these secondary carbonate deposits is a key issue for the accurate time reconstruction of environmental conditions. We present three 14C data sets for urban speleothem-like deposits that developed in contrasted man made environments. The first one was sampled in an underground technical gallery of the Palace of Versailles (France), and the other two in a manhole (Saint-Martin spring) of a historical underground aqueduct in Paris (France). The comparison of these records with the bomb peak and relative chronology (laminae counting) allowed us to identify: i) fast carbon transfer from the atmosphere to the urban underground; ii) a high proportion of dead carbon and a high damping effect in relation to possible old carbon stored within urban soils and/or the influence of local fossil carbon burning. This study also shows that the lamination of these deposits is bi-annual in these highly urbanized sites.
The daily time series Flare Index (FI) data of Northern Hemisphere, Southern Hemisphere and Total Disk for Solar Cycle 21- 23 and 24 up to Dec. 2014 has been pre-processed using a 2nd order exponential smoothing algorithm to remove orthogonal noise. The smoothed data in each case is processed for scaling analysis using Rescaled-Range Analysis as well as Finite Variance Scaling Method in order to search for the Hurst exponent. As the value of H obtained from our analysis lies in between 0 and 1, so it can be said that the signal may behave like Fractional Brownian Motion. Also, it is observed that H is less than 0.5 which indicates the data is anti-persistent in nature and it has a strong negative correlation within the signal. The value of H also indicates the oscillating features of the signal which might have some fundamental periodicities in the Suns atmosphere.
Artificial Neural Network based Nonlinear Autoregressive Model is designed to reconstruct and predict Forbush Decrease (FD) Data obtained from Izmiran, Russia. Result indicates that the model seems adequate for short term prediction of the FD data.