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This chapter provides an overview of body image disorders as they pertain to men. Body image encapsulates thoughts, beliefs, and feelings about one’s physical appearance. For some men, these thoughts, beliefs, and feelings are neutral, or even positive. This is ideal, insofar as one’s body ought to be a functional and useful asset that allows an individual to live life on their own terms. Yet for others, these thoughts, beliefs, and feelings are decidedly negative.
Treatment resistance causes significant burden in psychosis. Clozapine is the only evidence-based pharmacologic intervention available for people with treatment-resistant schizophrenia; current guidelines recommend commencement after two unsuccessful trials of standard antipsychotics.
This paper aims to explore the prevalence of treatment resistance and pathways to commencement of clozapine in UK early intervention in psychosis (EIP) services.
Data were taken from the National Evaluation of the Development and Impact of Early Intervention Services study (N = 1027) and included demographics, medication history and psychosis symptoms measured by the Positive and Negative Syndrome Scale (PANSS) at baseline, 6 months and 12 months. Prescribing patterns and pathways to clozapine were examined. We adopted a strict criterion for treatment resistance, defined as persistent elevated positive symptoms (a PANSS positive score ≥16, equating to at least two items of at least moderate severity), across three time points.
A total of 143 (18.1%) participants met the definition of treatment resistance of having continuous positive symptoms over 12 months, despite treatment in EIP services. Sixty-one (7.7%) participants were treatment resistant and eligible for clozapine, having had two trials of standard antipsychotics; however, only 25 (2.4%) were prescribed clozapine over the 12-month study period. Treatment-resistant participants were more likely to be prescribed additional antipsychotic medication and polypharmacy, instead of clozapine.
Prevalent treatment resistance was observed in UK EIP services, but prescription of polypharmacy was much more common than clozapine. Significant delays in the commencement of clozapine may reflect a missed opportunity to promote recovery in this critical period.
The aim of this study was to carry out the first ever study of gaming characteristics of individuals engaging in online gaming in Ireland and to ascertain whether features of gaming disorder are present in this population.
An online survey (comprising 21 questions – 3 demographic questions and 18 questions related to gaming and gaming disorder) was distributed on numerous Irish online gaming forums and Irish online gaming communities. Participants were self-selected and invited to compete the online survey containing questions related to gaming behaviours (age of onset, hours played on weekdays/weekends, type of device used), mobile gaming, motives for online gaming, use of microtransactions, engagement in esports, and a screening tool for the presence of gaming disorder.
A total of 166 participants engaged in the online survey. Among this study population of regular gamers in Ireland, 2.4% of the study population were classified as having gaming disorder, with up to 5.4% showing some evidence of disordered gaming. The main motivation for online gaming in the non-disordered gaming group was recreation (13.3, sd = 2.7) but only the fourth main motivation in the disordered gaming group behind competition (16.3, sd = 3.7), escape (16.2, sd = 4.3), and coping (15.1, sd = 3.7). Increased hours of gameplay on weekdays and weekends were noted in the disordered gaming group compared to non-disordered gamers.
A small percentage of gamers in Ireland demonstrate disordered gaming characteristics and gaming disorder, consistent with data from other international studies. Epidemiological studies are required in Ireland to enhance our knowledge of this disorder.
A new fossil site in a previously unexplored part of western Madagascar (the Beanka Protected Area) has yielded remains of many recently extinct vertebrates, including giant lemurs (Babakotia radofilai, Palaeopropithecus kelyus, Pachylemur sp., and Archaeolemur edwardsi), carnivores (Cryptoprocta spelea), the aardvark-like Plesiorycteropus sp., and giant ground cuckoos (Coua). Many of these represent considerable range extensions. Extant species that were extirpated from the region (e.g., Prolemur simus) are also present. Calibrated radiocarbon ages for 10 bones from extinct primates span the last three millennia. The largely undisturbed taphonomy of bone deposits supports the interpretation that many specimens fell in from a rock ledge above the entrance. Some primates and other mammals may have been prey items of avian predators, but human predation is also evident. Strontium isotope ratios (87Sr/86Sr) suggest that fossils were local to the area. Pottery sherds and bones of extinct and extant vertebrates with cut and chop marks indicate human activity in previous centuries. Scarcity of charcoal and human artifacts suggests only occasional visitation to the site by humans. The fossil assemblage from this site is unusual in that, while it contains many sloth lemurs, it lacks ratites, hippopotami, and crocodiles typical of nearly all other Holocene subfossil sites on Madagascar.
Gaming disorder is set to be included in the International Statistical Classification of Diseases and Related Health Problems alongside other behavioural addictions (gambling disorder) and substance-related addictions. Given the popularity of online gaming, this is set to become an increasingly common presentation to general mental health professionals, addiction specialists, and general practitioners. This article briefly examines online gaming and describes the characteristics of gaming disorder. Some features of online gaming that have addictive potential and similarities to other addictive behaviours such as gambling disorder are discussed. Finally, the article examines treatment options available for gaming disorder and treatment going forward from an Irish perspective.
We estimate the values of bull phenotypic traits, performance measurements, and expected progeny differences (EPDs) over time using bull sale data from an auction in Tennessee from 2006 to 2016. Moreover, we determine how a state partial-cost reimbursement program for bulls with certain EPDs affects bull sale price. Purebred seed stock producers in this region should focus on selling large, fast-growing, mature bulls that produce lighter calves for reduced calving stress. The state cost-share payment did not significantly increase bull prices in most years, meaning this payment was retained by cow-calf producers in most years.
In-patients in crisis report poor experiences of mental healthcare not conducive to recovery. Concerns include coercion by staff, fear of assault from other patients, lack of therapeutic opportunities and limited support. There is little high-quality evidence on what is important to patients to inform recovery-focused care.
To conduct a systematic review of published literature, identifying key themes for improving experiences of in-patient mental healthcare.
A systematic search of online databases (MEDLINE, PsycINFO and CINAHL) for primary research published between January 2000 and January 2016. All study designs from all countries were eligible. A qualitative analysis was undertaken and study quality was appraised. A patient and public reference group contributed to the review.
Studies (72) from 16 countries found four dimensions were consistently related to significantly influencing in-patients' experiences of crisis and recovery-focused care: the importance of high-quality relationships; averting negative experiences of coercion; a healthy, safe and enabling physical and social environment; and authentic experiences of patient-centred care. Critical elements for patients were trust, respect, safe wards, information and explanation about clinical decisions, therapeutic activities, and family inclusion in care.
A number of experiences hinder recovery-focused care and must be addressed with the involvement of staff to provide high-quality in-patient services. Future evaluations of service quality and development of practice guidance should embed these four dimensions.
Declaration of interest
K.B. is editor of British Journal of Psychiatry and leads a national programme (Synergi Collaborative Centre) on patient experiences driving change in services and inequalities.
The Viking Age in the West has long been perceived as a direct, colonising expansion of Scandinavian peoples, its causes most frequently sought within Scandinavia and linked together as concerted phenomena. This debate piece seeks to question these assumptions. Drawing on recent research that stresses the heterogeneity of Viking war-bands—and their early involvement in Francia and England—it proposes a ‘southern route’ through which Viking influence flowed towards the North Atlantic. The saga-attested early dominance of Norway over the Northern Isles is challenged, and attributed to a politicised re-writing of history four centuries later.
SNP in the vitamin D receptor (VDR) gene is associated with risk of lower respiratory infections. The influence of genetic variation in the vitamin D pathway resulting in susceptibility to upper respiratory infections (URI) has not been investigated. We evaluated the influence of thirty-three SNP in eleven vitamin D pathway genes (DBP, DHCR7, RXRA, CYP2R1, CYP27B1, CYP24A1, CYP3A4, CYP27A1, LRP2, CUBN and VDR) resulting in URI risk in 725 adults in London, UK, using an additive model with adjustment for potential confounders and correction for multiple comparisons. Significant associations in this cohort were investigated in a validation cohort of 737 children in Manchester, UK. In all, three SNP in VDR (rs4334089, rs11568820 and rs7970314) and one SNP in CYP3A4 (rs2740574) were associated with risk of URI in the discovery cohort after adjusting for potential confounders and correcting for multiple comparisons (adjusted incidence rate ratio per additional minor allele ≥1·15, Pfor trend ≤0·030). This association was replicated for rs4334089 in the validation cohort (Pfor trend=0·048) but not for rs11568820, rs7970314 or rs2740574. Carriage of the minor allele of the rs4334089 SNP in VDR was associated with increased susceptibility to URI in children and adult cohorts in the United Kingdom.