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Both typical and atypical antipsychotic psychotropics have been reported to cause ischemic priapism presumptively secondary to alpha1-adrenergic blockade. This condition is a urologic emergency for if not evaluated and treated appropriately, long-term sequelae include erectile dysfunction and impotence. This paper addresses the first reported case of priapism requiring surgical intervention presumed to be secondary to ziprasidone. Increased clinician and patient education regarding priapism is required in order to minimize this adverse event and to maximize immediate treatment.
How are intelligence and creativity related? Given the dynamic and complex nature of both constructs, this question is a nuanced one. This chapter first discusses how creativity is represented in intelligence theories (such as Guilford’s Structure of Intellect, CHC, and successful intelligence, and how intelligence is represented in creativity theories (such as systems and componential theories, domain-based theories, and cognitive theories). Next, empirical studies are reviewed. The threshold theory, which proposes that intelligence and creativity are related but only up to about an IQ of 120, has received mixed support. More recent studies using sophisticated statistical analyses have found more evidence. A reliance on measures of divergent thinking and g as the sole tests of creativity and intelligence may also limit much existing research.
Most research on the prevalence, distribution, and psychiatric comorbidity of intellectual disability (ID) relies on clinical samples, limiting the generalizability and utility of ID assessment in a legal context. This study assessed ID prevalence in a population-representative sample of US adolescents and examined associations of ID with socio-demographic factors and mental disorders.
Data were drawn from the National Comorbidity Survey Adolescent Supplement (N = 6256). ID was defined as: (1) IQ ⩽ 76, measured using the Kaufman Brief Intelligence Test; (2) an adaptive behavior score ⩽76, and (3) age of onset ⩽18 measured using a validated scale. The Composite International Diagnostic Interview assessed 15 lifetime mental disorders. The Sheehan disability scale assessed disorder severity. We used logistic regression models to estimate differences in lifetime disorders for adolescents with and without ID.
ID prevalence was 3.2%. Among adolescents with ID, 65.1% met lifetime criteria for a mental disorder. ID status was associated with specific phobia, agoraphobia, and bipolar disorder, but not behavior disorders after adjustment for socio-demographics. Adolescents with ID and mental disorders were significantly more likely to exhibit severe impairment than those without ID.
These findings highlight how sample selection and overlap between ID and psychopathology symptoms might bias understanding of the mental health consequences of ID. For example, associations between ID and behavior disorders widely reported in clinical samples were not observed in a population-representative sample after adjustment for socio-demographic confounders. Valid assessment and understanding of these constructs may prove influential in the legal system by influencing treatment referrals and capital punishment decisions.
General Scientific Summary
Current definitions of intellectual disability (ID) are based on three criteria: formal designation of low intelligence through artificial problem-solving tasks, impairment in one's ability to function in his/her social environment, and early age of onset. In a national population sample of adolescents, the majority of those with ID met criteria for a lifetime mental disorder. Phobias and bipolar disorder, but not behavior disorders, were elevated in adolescents with ID. Findings highlight the need to consider how behavioral problems are conceptualized and classified in people with ID.
Antibiotic overuse has promoted growing rates of antimicrobial resistance and secondary antibiotic-associated infections such as Clostridium difficile (C. difficile). Antimicrobial stewardship programs (ASPs) are effective in reducing antimicrobial use in the inpatient setting; however, the unique environment of the emergency department (ED) lends itself to challenges for successful implementation. Front-line ownership (FLO) methodology has been shown to be a potentially effective strategy for the implementation of inpatient ASPs through an iterative multi-pronged approach driven by front-line providers.
To determine whether a FLO approach to antimicrobial stewardship in the ED can alter antimicrobial usage.
Interventions were driven by ED physicians and facilitated by Infectious Diseases Division physicians from the hospital’s ASP using FLO principles. Measured end points included antibiotic usage in the ED as measured by defined daily doses, and rates of urine culture sent from the ED.
There was a step-wise significant reduction in the use of azithromycin (p=0.006), ceftriaxone (p=0.045), ciprofloxacin (p=0.034), and moxifloxacin (p=0.008). There was also a significant reduction in rates of urine cultures (p<0.001) by 2.26 urine cultures per 100 ED patient visits.
FLO offers a promising approach to successful implementation of an ASP in the ED. Future studies would be important to evaluate the generalizability of the FLO approach to ASP development in other EDs and to determine strategies to improve the sustainability of reductions in antimicrobial use.
The first portion of this chapter reviews the concept of emotional intelligence. Some attention is paid to what is meant by the terms emotion, intelligence, and emotional intelligence. A distinction is drawn between models of emotional intelligence that focus on mental abilities and alternative models that, increasingly, are recognized as speaking more generally of personality. Measures of emotional intelligence are examined in the chapter's second section. Findings concerning what emotional intelligence predicts are the topic of the chapter's third section. There is an increasing call to weed out those conceptualizations that do not make sense to be called emotional intelligence. Alternatively, they can be transplanted in the soil of personality psychology, where they better belong. Current research suggests that mental ability models of emotional intelligence can be described as a standard intelligence, and they empirically meet the criteria for a standard intelligence.
The role of maintenance therapy in the treatment of patients with multiple myeloma is currently under extensive evaluation. Maintenance therapy is defined as the addition of chronically applied therapy, following induction in responding or stable patient, with the goal of prolonging survival (ASH:FDA Workshop). Prolonged conventional chemotherapy has not only proven to be ineffective as maintenance therapy, but it is also associated with an increased risk of secondary myelodysplastic syndromes. Interferon α and corticosteroids have also been evaluated as maintenance therapy, but these treatments demonstrated marginal benefit at the cost of excessive toxicity. Recent studies have evaluated the role of maintenance thalidomide with hints that for certain subsets there may be a significant benefit. Additional studies are ongoing, testing the combination of thalidomide and corticosteroids, lenalidomide, and bortezomib in the maintenance setting. Future studies will need to identify not only the relative benefit for these agents in the maintenance setting but also the role cytogenetic risk groups play on the relative benefit of maintenance approaches.
Multiple myeloma is an incurable malignancy characterized by the accumulation of malignant plasma cells. Treatment options for patients with myeloma have utilized alkylator-based therapy in conjunction with corticosteroids, and more recently, the widespread use of high-dose therapy and autologous transplant has improved overall survival (OS) for many of these patients. These improvements in OS have been associated with improving the rate of complete remission, a disease state not known to be associated with a cure but with superior long-term outcomes.
There is likely to be widespread agreement with much of the FDA’s rationale for approving BiDil (a combination of hydralazine hydrochloride and isosorbide dinitrate; H-I) as a treatment for heart failure. In particular, most would agree that the evidence of effectiveness provided by the African American Heart Failure Trial (A-HeFT) is compelling. Likewise, few health scientists would believe that it is either necessary or responsible to withhold therapies such as BiDil from those who might benefit until there is a full understanding of how they work. And although there is substantial concern that biomedical differences between racial groups are routinely misinterpreted as evidence of innate genetic differences (hence Jonathan Kahn’s call for all such claims to be supported by genetic evidence), most would concede that using race as a “descriptive” variable can help identify differences in health and access/response to treatment that might warrant further investigation or intervention.
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