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The Danish Longitudinal Study on Alcoholism was designed to identify predictors of adult male alcoholism. The present study examines the predictability of premorbid personality disorders.
Subjects were selected from a Danish birth cohort (n = 9125, born 1959 – 61) that included 223 sons of alcoholic fathers (high risk = HR) and 106 matched sons of non-alcoholics (low risk = LR). These subjects have been studied systematically over the past 40 years. Most recently, they were evaluated at age 40 (n = 202) by a psychiatrist using structured interviews and DSM-III-R criteria to diagnose an Alcohol Use Disorder.
HR subjects were more likely than LR subjects to develop alcohol dependence over the past 40 years (31% vs. 16%, p < .03). However, HR subjects were not more likely to develop alcohol abuse (17% vs. 15%). Both ADHD (as measured by school teachers) and ASPD (onset before age 15) predicted alcoholism independently at age 40. ADHD and ASPD were much stronger independent predictors of adult alcoholism than parental risk status. Other personality and anxiety disorders did not predict an alcoholic outcome.
Paternal alcoholism predicted alcohol dependence in sons at age 40. But the most predictive premorbid variables were ASPD and ADHD, both with onset in childhood and adolescence.
Little is known about the excess mortality associated with use of some illicit substances. In particular, this concerns the risks associated with injection drug use and psychiatric disorders.
This study estimated mortality following substance abuse treatment among primary users of cannabis, cocaine, amphetamine, MDMA, and opioids. The risks associated with injection drug use and psychiatric comorbidity were assessed.
A register of individuals in treatment for illicit substance disorders was linked with registers on psychiatric treatment and mortality. The study population consisted of 20581 individuals who received treatment in Denmark between 1996 and 2006. There were 1441 deaths recorded over 111445 person-years of follow-up.
Standardized Mortality Ratios (SMRs) for primary users of specific substances were: Cannabis: 4.9, cocaine: 6.4, amphetamine: 6.0, heroin: 9.1, and other opioids 7.7. For MDMA the crude mortality rate was 1.75/1000 person-years, and the SMR was not significantly elevated. Sharing of syringes was associated with increased mortality in both primary users of opioids (hazard ratio (HR): 1.58 [95% CI 1.22–1.99], p < .001) and cocaine/amphetamine (HR: 9.52 (95% CI 3.94–23.02, p < .001). Overall, psychiatric comorbidity was associated with modestly increased mortality (HR: 1.15 [95% CI 1.03–1.29], p = .012) and in particular for primary users of cocaine/amphetamine (HR: 2.74 [95% CI 1.56–4.80], p < .001).
High SMRs were found among individuals who had received treatment for cannabis, cocaine, amphetamine, and opioid use disorders. Injection drug use was clearly associated with excess mortality, while the impact of psychiatric comorbidity was generally modest.
The presence of affective symptoms in panic disorder has often been reported. Data from The Cross-National Collaborative Panic Study (second phase) were analysed to address the role of dysthymia in panic disorder with respect to previous illness, current psychopathology and the outcome during an 8-week study of alprazolam and imipramine. A group of dysthymic patients without current or past major depressive episode was studied. The prevalences of dysthymia varied markedly across participating sites: 2–13%. Only a few clinical characteristics of dysthymic panic disorder patients were found. They had suffered from panic disorder for a few years more than patients without affective disorder and they were slightly older. The outcome after the 8-week drug trial was not significantly different from that of patients without affective disorder. Hence, dysthymia was not suggested to be of major clinical relevance for the phenomenology of panic disorder or for the outcome of drug treatment.
Cardiometabolic diseases are under-diagnosed and under-treated in psychiatric inpatients. A common solution is implementation of screening guidelines. However, we often forget to ask the essential question: Why were our patients underdiagnosed in the first place?
To identify causes of under-diagnosing and under-treatment in the context of local clinical practices.
All consecutive admissions (n=63) over 93 days were screened for hypertension, diabetes, dyslipidemias and abdominal obesity. Patients identified with both (a) undiagnosed and untreated disease and (b) admission on a separate occasion within the previous two years to the ward in question, were selected for a retrospective patient file review. These patients (n=32) had their medical records scrutinized for information on how each cardiometabolic measure was assessed at previous admission.
Relevant examination were performed in 38% of cases and test results were abnormal for 54% of these. Abnormal test results were evaluated in 14% of cases and none of the evaluated results were acted upon.
Rigorous examination and testing of patients is only of value if clinicians have the essential knowledge to interpret the results and feel responsibility to do so. These barriers must be broken down before implementing screening guidelines in routine clinical practice.
This study estimated Standardized Mortality Ratios (SMRs) for accidents, suicide, homicide, and natural causes following treatment for cannabis use disorders. Predictors of death within the sample and the time of death in relation to treatment start and ending were determined.
This was a register-based cohort study of 6445 individuals in treatment for cannabis use disorders in Denmark between 1996 and 2006. The register of individuals in treatment for cannabis use disorders was linked with registers on causes of death and psychiatric treatment. The sample was followed after treatment entry and 142 deaths were recorded during 26584 person-years of follow-up.
The all-cause Standardized Mortality Ratio (SMR) was 4.9. For different causes of death the SMRs were: accidents: 8.2 (95% CI 6.3–10.5), suicide: 5.3 (95% CI 3.3–7.9), homicide: 3.8 (95% CI 1.5–7.9), and natural causes: 2.8 (95% CI 2.0–3.7). Secondary opioid use predicted all-cause mortality as well as death from accidents and homicide, while higher age predicted all-cause mortality and death from natural causes. After exclusion of those with secondary opioid use, excess mortality from homicide was no longer observed, while SMR's associated with other causes of death remained largely unchanged. The SMR was 17 in the first two weeks after treatment start, fell during the following year, and rose again thereafter. No excess mortality was observed following the end of treatment.
Individuals with cannabis use disorders have highly increased mortality from accidents, suicide, homicide, and natural causes.
Psychotic depression (PD) is classified as a sybtype of severe depression in the current diagnostic manuals. Accordingly, it is a common conception that psychotic features in depression arise as a consequence of depressive severity.
To determine whether the severity of depression and psychosis correlate in accordance with the “severity-psychosis” hypothesis and to detect potential differences in clinical features of psychotic and non-psychotic depression (non-PD).
We aimed to answer the following questions:
Does the clinical profile differ between patients with PD and non-PD?
Is the severity of depression and psychosis correlated in patients with depression?
Quantitative analysis of Health of the Nation Outcome Scales (HoNOS) scores from all patients admitted to a Danish general psychiatric hospital between 2000 and 2010 due to a severe depressive episode.
A total of 357 patients with severe depression, of which 125 (35%) were of the psychotic subtype, formed the study sample. Mean HoNOS scores at admission differed significantly between patients with non-PD and PD on the items hallucinations and delusions (non-PD = 0.33 vs. PD = 1.37, p < 0.001), aggression (non-PD = 0.20 vs. PD = 0.36, p = 0.044) and on the total score (non-PD = 10.55 vs. PD = 11.87, p = 0.024). the HoNOS scores on the two items “depression” and “hallucinations and delusions” were very weakly correlated (Spearman coefficient = 0.12).
The results suggest that the severity of depression is unlikely to be the key determinant for the development of psychosis and supports the hypothesis that the psychotic- and non-psychotic subtypes of depression are in fact distinct clinical syndromes.
Poor insight has a negative impact on the outcome in schizophrenia; consequently, poor insight is a logical target for treatment. However, neither medication nor psychosocial interventions have been demonstrated to improve poor insight. A method originally designed for diabetes patients to improve their illness management, Guided Self-Determination (GSD), has been adapted for use in patients with schizophrenia (GSD-SZ). The purpose of this study was to investigate the effect on insight of GSD-SZ as a supplement to treatment as usual (TAU) as compared to TAU alone in outpatients diagnosed with schizophrenia. The design was an open randomized trial. The primary hypothesis was cognitive insight would improve in those patients who received GSD-SZ + TAU as assessed by the BCIS. We additionally explored whether the intervention led to changes in clinical insight, self-perceived recovery, self-esteem, social functioning and symptom severity. Assessments were conducted at baseline, and at 3-, 6- and 12-month follow-up. Analysis was based on the principles of intention to treat and potential confounders were taken into account through applying a multivariate approach. A total of 101 participants were randomized to GSD-SZ + TAU (n = 50) or to TAU alone (n = 51). No statistically significant differences were found on the cognitive insight. However, at 12-month follow-up, clinical insight (measured by G12 from the Positive and Negative Syndrome Scale), symptom severity, and social functioning had statistically significantly improved in the intervention group as compared to the control group. “Improving insight in patients diagnosed with schizophrenia”, NCT01282307, http://clinicaltrials.gov/.
US primary care clinicians (PCCs) are increasingly assuming the medical management for psychiatric disorders. Clinical practice guidelines (PCGs) remain gold standard for professional care, yet physician adoption is not universal. We sought identification of methods to increase evidence-based mental health practices for the most commonly diagnosed pediatric behavioral condition, attention deficit hyperactivity disorder (ADHD).
Test two psychiatric interventions of different intensity levels, both designed to increase primary care clinicians’ use of PCGs for managing ADHD.
Increase PCCs’ use of PCGs for managing ADHD.
Participants: 70 North Carolina (NC) PCCs ; 70 case managers; 35 to 40 pediatric resident physicians; 420 pediatric government-insured patients ages 6-18 years (chart abstraction only).
Procedures: PCCs were randomized to:
(1) PCC training and follow-up support only; or
(2) PCC, case manager, and office staff training (collaborative) and follow-up support interventions.
Differences in knowledge, skills, attitudes, and ADHD assessment and treatment practices assessed by participant selfcompleted surveys at baseline, 6, and 12 months. Six of their patient charts were abstracted to determine the extent they followed American Academy of Pediatrics (AAP) treatment guidelines. NC Medicaid (government insurance) claims for children and adolescents of participating practices and a group of control practices were reviewed for diagnostic documentation.
For collaborative trained PCCs:
(1) increased use of ADHD symptom screeners and greater frequency of F/U visits;
(2) greater identification of children with ADHD, but decrease in the probability of receiving an ADHD medication
(3) lower rate of prescribing above dosing guidelines.
Electric indoor lighting can disturb sleep and increase depressive symptoms; both common complaints in psychiatric inpatients.
To improve quality of sleep in patients using an indoor hospital lighting environment simulating nature in intensity, color, and circadian timing.
Investigator-blinded parallel group randomized controlled effectiveness trial supplied with qualitative interviews in an inpatient psychiatric ward with fully automatic and adjustable lighting. Admitted patients received a room with a naturalistic lighting environment (intervention group) or lighting as usual (control group). The primary outcome was the Pittsburg Sleep Quality Index and secondary outcomes included the Major Depression Inventory and WHO-five Well- Being Index.
In this ongoing trial, we included 28 patients (16 treated and 12 controls). Patients in the intervention group reported higher subjective sleep quality and sleep efficiency, lower use of sleep medication (mean difference, 4.68 mg; 95% CI, 0.54; 53.5), fewer depressive symptoms (mean difference, 5; 95% CI,–2; 13), but lower well-being (difference,–4 percentage points; 95% CI,–20; 16), compared with the control group. At discharge, fewer patients in the intervention group had experienced use of involuntary treatment. Qualitative data indicated no side effects apart from issues in performing indoor leisure activities in dim light.
A naturalistic lighting environment was safe and improved sleep and mood in our small patient sample. The trial integrated well with routine clinical care and our sample reflected the heterogeneity of the target population (Funded by Region Midtjylland and others; Clinicaltrials.gov number, NCT02653040)
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Early changes in biomarker levels probably occur before bloodstream infection (BSI) is diagnosed. However, this issue has not been fully addressed. We aimed at evaluating the kinetics of C-reactive protein (CRP) and plasma albumin (PA) in the 30 days before community-acquired (CA) BSI diagnosis. From a population-based BSI database we identified 658 patients with at least one measurement of CRP or PA from day −30 (D–30) through day −1 (D–1) before the day of CA-BSI (D0) and a measurement of the same biomarker at D0 or D1. Amongst these, 502 had both CRP and PA measurements which fitted these criteria. CRP and PA concentrations began to change inversely some days before CA-BSI diagnosis, CRP increasing by day −3.1 and PA decreasing by day −1.3. From D–30 to D–4, CRP kinetics (expressed as slopes – rate of concentration change per day) was −1.5 mg/l/day. From D–3 to D1, the CRP slope increased to 36.3 mg/l/day. For albumin, the slope between D–30 to D–2 was 0.1 g/l/day and changed to −1.8 g/l/day between D–1 and D1. We showed that biomarker levels begin to change some days before the CA-BSI diagnosis, CRP 3.1 days and PA 1.3 days before.
Tail biting is a welfare and economical concern in modern pig production. One common preventive measure used throughout the world is tail docking, which is generally considered one of the most effective methods for limiting tail biting. However, tail docking is a painful mutilation and systematic tail docking is not allowed in the EU. Therefore, the aim was to compare pig behaviour and the prevalence of tail biting in finishing pigs with intact tails housed in two different pen designs under Danish commercial conditions. PEN1 was a traditional Danish pen and PEN2 was inspired by Swedish finisher pen design and had a larger proportion of solid floor area (PEN1: 1/3 and PEN2: 2/3), reduced group size (PEN1: 15 and PEN2: 12), increased space allowance per head (PEN1: 0.7 m2 and PEN2: 0.89 m2) and straw allocated on the floor (PEN2) whereas straw was provided in a straw rack in PEN1. Tail damage observations were carried out daily by the stockperson and every 2 weeks one trained research technician assessed tail damages according to a tail scoring system. Tail lesions were observed in 51% of PEN1 and in 11% of PEN2 (P < 0.001). PEN1 had higher prevalence of tail damages than PEN2 (23% v. 5%, P < 0.001). Behavioural observations were carried out by the use of video recordings. Pigs in PEN2 tended to spend more time on tail-directed behaviour than pigs in PEN1 (P = 0.07), whereas pigs in PEN1 tended to spend more time on ear-directed behaviour (P = 0.08). Pigs in PEN2 spent more time on straw-directed behaviour compared to pigs in PEN1 (P < 0.001). Pen design did not affect time spent on other penmate-directed behaviour. In addition, the level of welfare between the two pen designs was compared using the Welfare Quality® protocol. PEN2 received an overall score of ‘excellent’ while PEN1 scored ‘enhanced’. PEN2 scored higher on all principles besides ‘good health’, where PEN1 scored better on lameness and wounds. The main measurements accounting for the differences were water supply, huddling, tail biting, social behaviour and fear of humans. In conclusion, the combination of increased space allowance, increased area of solid flooring, straw allocated onto the floor and reduced group size (PEN2) resulted in fewer tail damaged pigs and a better overall welfare assessment, despite a tendency for more tail-directed behaviour.
We perform an experimental analysis of co-current, stratified wavy pipe flow, with the aim of investigating the effect of small scale wave breaking (microscale breaking) on the airflow. Particle image velocimetry is applied simultaneously in the gas and liquid phases. Active wave breaking is identified by high levels of vorticity on the leeward side of individual waves, and the statistics of the airflow above breaking and non-breaking waves are extracted from the gas-phase velocity fields. Keeping the liquid superficial velocity constant (
), we consider two experimental cases of different gas flow rates. The lowest flow rate (
) is slightly higher than the onset of microscale breaking, while the higher flow rate (
) is within the regime where wave breaking is observed to be frequent, and the root-mean-square interface elevation
is independent of gas flow rate. Results show that for the lowest gas flow rate considered, active wave breaking has a stabilizing effect on the airflow above the waves, reducing the sheltered region on the leeward side of the wave and the turbulence above the wave crest compared with non-breaking waves at similar steepness. At the higher gas flow rate the effect of active wave breaking is found to be small, and the main geometrical properties of the waves are found to dominate the evolution of the separated flow region.
Cystic echinococcosis caused by Echinococcus granulosus is a major zoonosis of public health significance in the Patagonian region of Argentina. This investigation sought to test the hypothesis that the persistence and dispersion of the parasite eggs can be explained by physical and meteorological parameters along with final host infection and behaviour. This observational study was carried out over a five-year period within an enclosure where two dogs harbouring a worm burden ranging from 100 to 1000 mature adult E. granulosus, as well as two uninfected dogs, had previously been kept for six months. Environmental canine faeces, topsoil, pond water, and sediment samples were examined to control for the presence of eggs and coproantigens of the parasite using microscope-based techniques and copro-ELISA plus copro-Western Blot tests. The parasite eggs were detected up to 41 months later in faeces from infected dogs, soil and sediment, and coproantigen tests remained positive for up to 70 months in faeces. Overall, parasite eggs were found within a maximum distance of 115 m from the contaminated dog faeces deposition site. Our findings indicate that under Patagonian environmental conditions, egg persistence and dispersion seem to be related to the worm burden and habits of the infected dog, to prevailing wind direction and to the existence of low bushes as well as natural bodies of water. The present study is the first to provide direct evidence of interaction between bioclimatic conditions and E. granulosus egg dispersion under Patagonian field conditions.
Tennessee cattle producer willingness to participate in a hypothetical Tennessee Branded Beef Program (TBBP) was examined using 2016 survey data. Willingness to participate in the TBBP was modeled using a probit model. Among those willing to participate, a Tobit model was used to estimate the pounds of live-weight beef producers were willing to supply into a TBBP. Age, production practices, and risk attitudes influenced willingness to participate. Among those willing to participate, projected TBBP supply per farm averaged 32,329 pounds and was influenced by on-farm animal units, production practices, perceived barriers, risk attitudes, and consequentiality beliefs.
Although Tennessee has Advanced Master Beef Producer (AMBP) and Beef Quality Assurance (BQA) certifications for cattle producers, currently there is no state-certified beef labeling program. A choice experiment was administered to Tennessee consumers to determine their willingness to pay for Tennessee Certified Beef (TCB) and other attributes such as labels indicating producer participation in AMBP and BQA. Random parameter logit model results indicate consumers most valued TCB steak and no-hormones-administered ground beef. Consumers also valued many labels when appearing alongside the TCB label. The impact of providing participants label definitions prior to the choice experiment was examined.
Community-acquired bacteraemia patients (n = 2472), Denmark, 2000–2008. Albumin, C-reactive protein (CRP) and haemoglobin (Hb) measured 2000–2010. We assessed daily mean levels of albumin, CRP and Hb from 30 days before to 30 days after bacteraemia and correlations between albumin vs. CRP and albumin vs. Hb. In linear regression models, we evaluated the contribution of CRP, Hb, chronic and acute variables to the albumin level variations. The mean albumin level (33.6 g/l) was steady before day 1, declined to 29.3 g/l on day 1 with little increase afterward. The mean CRP increased from day −5, peaked on day 1 and declined thereafter. The mean Hb level was fairly constant during days −30/30. Albumin was inversely (R range, − 0.18/–0.47, P < 10−4) correlated with the CRP level and positively (R = 0.17–0.46, P < 10−4) correlated with the HB level. In most models, CRP was the first variable that contributed to the albumin variations, 34–70% of the full model. The sudden decrease of albumin levels, without sudden fluctuations of CRP or Hb, indicated that hypoalbuminaemia was a marker of trans-capillary leakage.