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Background: Walking aids such as crutches, canes and walkers are used by 2 million Canadians. Repetitive weight-bearing with walking aids may cause upper limb peripheral nerve injury. The objectives of this review were to: 1) identify types of nerve injuries reported with walking aids; 2) report electrodiagnostic findings; 3) identify typical treatment strategies; and 4) determine expected recovery time for such injuries. Methods: MEDLINE, EMBASE, CINAHL and Cochrane Library were searched for primary data in English published between 1950-2022. Abstracts were reviewed independently by 2 authors. Full-text reviews were independently conducted by 2 authors. Results: The search identified 3746 abstracts, 43 of which underwent full-text review. 31 studies were included. There were 144 cases of peripheral nerve injury. Crutches caused the most injuries (n=21 studies). The ulnar nerve was most commonly injured (n=27 cases). Improper walking aid fit was identified as a risk factor in 74% of cases. Stopping walking aid use was the most common treatment strategy (n=10 studies). Follow-up reports (n=20) indicated 65% of patients experienced recovery at 6 months. Conclusions: Improper walking aid fit and use were identified as major injury risk factors. A national program to teach patients and clinicians how to use walking aids may reduce injury risk.
Excessive breeding for brachycephaly (fore-shortened muzzle) has led to increasing problems in pugs related to brachycephalic airway syndrome (BAS). Consequently, the German Pug Club (Deutscher Mopsclub eV; DMC) established a stress test in 2009 that must be passed for breeding and requires normalised heart and respiratory rates 15 min after having covered a distance of 1 km. In this study, 42 pugs underwent the stress test under standardised conditions. Taking into account that this exercise should not be too physically demanding for any healthy dog, the results were surprising: 14 of the pugs failed, ie a failure rate of 33.3%. In addition to the stress test, the pugs were assessed according to their heart and respiratory rates at rest, which we predicted would be associated with BAS, and in this test, 21 out of 42 pugs failed. Thus, 50.0% of the pugs were in a severely compromised physical condition. A further group of seven retropugs, ie a crossbreed of pugs with a slightly longer muzzle, was included in the study to compare brachycephalic problems. All of the retropugs passed the test, even when respiratory and heart rates at rest were considered. However, the findings may not be transferable to all retropugs because of the small sample size, so further research is needed. In summary, this study has enabled the development of recommendations for future implementation of stress tests.
Using capture-recapture analysis we estimate the effective size of the active Amazon Mechanical Turk (MTurk) population that a typical laboratory can access to be about 7,300 workers. We also estimate that the time taken for half of the workers to leave the MTurk pool and be replaced is about 7 months. Each laboratory has its own population pool which overlaps, often extensively, with the hundreds of other laboratories using MTurk. Our estimate is based on a sample of 114,460 completed sessions from 33,408 unique participants and 689 sessions across seven laboratories in the US, Europe, and Australia from January 2012 to March 2015.
Social connectedness might positively influence the course of clinical symptoms in people with psychotic disorders.
This study examines satisfaction with social connectedness (SSC) as predictor of positive and negative symptoms in people with a psychotic disorder.
Data from the Pharmacotherapy Monitoring and Outcome Survey (PHAMOUS, 2014-2019) was used from patients diagnosed with a psychotic disorder (N=2109). Items about social connectedness of the Manchester short assessment of Quality of Life (ManSA) were used to measure SSC. Linear mixed models were used to estimate the association of SSC with the Positive and Negative Syndrome Scale (PANSS) after one and two years against α=0.01. Analyses were adjusted for symptoms, time since onset, gender and age. Additionally, fluctuation of positive and negative symptom scores over time was estimated.
Mean duration of illness of the sample was 18.8 years (SD 10.7) with >65% showing only small variation in positive and negative symptoms over a two to five-year time period. After adjustment for covariates, SSC showed to be negatively associated with positive symptoms after one year (β=-0.47, p<0.001, 95% CI=-0.70,-0.25) and two years (β =-0.59, p<0.001, 95% CI = -0.88,-0.30), and for negative symptoms after one year (β=-0.52, p<0.001, 95% CI = -0.77,-0.27). The prediction of negative symptoms was not significant at two years.
This research indicates that interventions on SSC might positively impact mental health for people with psychosis. SSC is a small and robust predictor of future levels of positive symptoms. Negative symptoms could be predicted by SSC at one year.
The prevalence of psychotic experiences (PEs) is higher in low-and-middle-income-countries (LAMIC) than in high-income countries (HIC). Here, we examine whether this effect is explicable by measurement bias.
A community sample from 13 countries (N = 7141) was used to examine the measurement invariance (MI) of a frequently used self-report measure of PEs, the Community Assessment of Psychic Experiences (CAPE), in LAMIC (n = 2472) and HIC (n = 4669). The CAPE measures positive (e.g. hallucinations), negative (e.g. avolition) and depressive symptoms. MI analyses were conducted with multiple-group confirmatory factor analyses.
MI analyses showed similarities in the structure and understanding of the CAPE factors between LAMIC and HIC. Partial scalar invariance was found, allowing for latent score comparisons. Residual invariance was not found, indicating that sum score comparisons are biased. A comparison of latent scores before and after MI adjustment showed both overestimation (e.g. avolition, d = 0.03 into d = −0.42) and underestimation (e.g. magical thinking, d = −0.03 into d = 0.33) of PE in LAMIC relative to HIC. After adjusting the CAPE for MI, participants from LAMIC reported significantly higher levels on most CAPE factors but a significantly lower level of avolition.
Previous studies using sum scores to compare differences across countries are likely to be biased. The direction of the bias involves both over- and underestimation of PEs in LAMIC compared to HIC. Nevertheless, the study confirms the basic finding that PEs are more frequent in LAMIC than in HIC.
Impairments in social cognition contribute significantly to disability in schizophrenia patients (SzP). Perception of facial expressions is critical for social cognition. Intact perception requires an individual to visually scan a complex dynamic social scene for transiently moving facial expressions that may be relevant for understanding the scene. The relationship of visual scanning for these facial expressions and social cognition remains unknown.
In 39 SzP and 27 healthy controls (HC), we used eye-tracking to examine the relationship between performance on The Awareness of Social Inference Test (TASIT), which tests social cognition using naturalistic video clips of social situations, and visual scanning, measuring each individual's relative to the mean of HC. We then examined the relationship of visual scanning to the specific visual features (motion, contrast, luminance, faces) within the video clips.
TASIT performance was significantly impaired in SzP for trials involving sarcasm (p < 10−5). Visual scanning was significantly more variable in SzP than HC (p < 10−6), and predicted TASIT performance in HC (p = 0.02) but not SzP (p = 0.91), differing significantly between groups (p = 0.04). During the visual scanning, SzP were less likely to be viewing faces (p = 0.0001) and less likely to saccade to facial motion in peripheral vision (p = 0.008).
SzP show highly significant deficits in the use of visual scanning of naturalistic social scenes to inform social cognition. Alterations in visual scanning patterns may originate from impaired processing of facial motion within peripheral vision. Overall, these results highlight the utility of naturalistic stimuli in the study of social cognition deficits in schizophrenia.
This systematic review examines the effectiveness and cost-effectiveness of behavioural health integration into primary healthcare in the management of depression and unhealthy alcohol use in low- and middle-income countries. Following PRISMA guidelines, this review included research that studied patients aged ≥18 years with unhealthy alcohol use and/or depression of any clinical severity. An exploration of the models of integration was used to characterise a typology of behavioural health integration specific for low- and middle-income countries.
Fifty-eight articles met inclusion criteria. Studies evidenced increased effectiveness of integrated care over treatment as usual for both conditions. The economic evaluations found increased direct health costs but cost-effective estimates. The included studies used six distinct behavioural health integration models.
Behavioural health integration may yield improved health outcomes, although it may require additional resources. The proposed typology can assist decision-makers to advance the implementation of integrated models.
Lateral gaze aversions which follow reflective or thought provoking questions are called conjugated lateral eye movements (CLEMs). This response was studied in 20 schizophrenic patients, 20 depressive patients and 20 healthy controls. Frontal and parietal EEG measures were recorded simultaneously with the question/answer task. There were no differences in CLEMs among the 3 groups. Schizophrenic and depressive patients demonstrated a significantly reduced EEG-power on the left and an increased power on the right in comparison with healthy controls. This may point to a functional interhemispheric ‘disconnection’ in patients. Comparative correlations revealed EEG-power increase during the occurrence of contralateral CLEMs in the whole 10 min task.
Serum-antibodies against an organ specific CNS antigen as well as against serotonin and gangliosides (Gm 1) were analysed by ELISA in 34 patients with schizophrenia, ten patients with schizoaffective psychosis and 13 patients with major depressive disorder. Sixty-two patients with various rheumatic disorders and 32 blood donors were included in the study as controls. Sixty-two percent of the 13 patients with major depressive disorder had antibodies to serotonin and 69% to gangliosides, whereas antibody positive sera was only found in 38% of the 34 patients with schizophrenia. The same antibodies were found in only 6% (antibodies to serotonin) and 13% (antibodies to gangliosides) of the 32 blood donors and in a similar frequency in patients with schizoaffective psychosis. Organ specific antibodies to CNS-antigen could not be detected in the psychiatric patient group at any significant level. It is speculated that auto-immune reactions towards a serotonin receptor may be involved in the etiopathogenesis of major depressive disorder.
This paper reviews and presents data of practical impact for those administering electroconvulsive therapy (ECT). In the first section, physical and physiological aspects of the stimulus as well as methods of stimulation are discussed. The second section deals with indications for ECT, efficacy and treatment modalities such as seizure duration, treatment frequency and total number of ECT applications. The last section is devoted to side effects, risks, comedication and comorbidity.
From December 1–31, 1997, the Department of Psychiatry and Psychotherapy in co-operation with the Department of Information Technology, University of Tübingen, Germany, organised the first virtual congress on psychiatry in the Internet. The congress was aimed at facilitating exchange of results of psychiatric studies and ideas and at stimulating discussion among interested colleagues. Almost 100 participants from 17 countries on four continents took part in this event. Sixteen contributions were presented and discussed. The problems and opportunities of this medium in the organisation and running of congresses are presented and discussed. The experience gained in this congress suggests that the Internet will find increasing use as a medium for medical congresses within the next few years.
Sera from patients with major depressive disorder and paranoid schizophrenia were screened for antinuclear antibodies (antigens: ds-DNA, ENA, histone H3) and circulating immune complexes (CIC-Cq1) by ELISA. Controls were healthy blood donors. Only a few of the patients' sera were positive for anti-ds-DNA and anti-ENA antibodies. There was no significant result. In paranoid schizophrenia 20.5% of sera were positive for antibodies against histone H3. In the case of CIC-Cql, 7% of the patients with major depressive disorder and 11 % of those with paranoid schizophrenia were positive. Controls showed positive sera in 39%. This study disagrees with former studies which could demonstrate a series of antinuclear antibodies in mental disorders. In the case of antihistone antibodies, the present results could indicate an autoimmune process in a subgroup of schizophrenic patients.
Studies in the general population show cannabis use has a beneficial effect on metabolic disorders. Given the increased cardiometabolic risk in patients with psychotic disorders, as well as their prevalent use of cannabis, we aim to investigate whether such effects are also evident in these patients.
3176 patients with chronic psychotic disorders from mental health institutions in the Netherlands were included in the study. With multivariate regression analyses we examined the effects of cannabis use on metabolic risk factors; BMI, waist circumference, blood pressure (BP), cholesterol, HDL-C, LDL-C, triglycerides, glucose and HbA1c. Age, sex, smoking, alcohol use and antipsychotic drugs were included as confounders. Next, we examined change in metabolic risk factors after one-year follow up for cannabis users, non-users, discontinuers and starters.
We found a significant negative association between cannabis use and BMI (p=0.003), waist circumference (p>0.001), diastolic BP (p=0.015) and HbA1c (0.004). One year later, patients who had discontinued their cannabis use had a greater increase of BMI (p=0.002) and waist circumference (p=0.011) than other patients. They also had a greater increase of diastolic BP than non-users (p=0.036) or starters (p=0.004).
Discontinuation of cannabis use increased metabolic risk. To stop cannabis use is often an important treatment goal, because it reduces psychotic symptoms. However, physicians should be aware of the increased metabolic risk in patients who discontinue the use of cannabis. Extra attention should be paid to monitoring and treatment of metabolic parameters in these patients to prevent cardiovascular diseases and premature cardiovascular mortality.
The effectiveness of systematic quality improvement initiatives in psychiatric care remains unclear.
To elucidate the adherence to recommended evidence-based guidelines in clinical practice.
To examine whether the quality of care among patients hospitalized with schizophrenia has changed following the implementation of a systematic monitoring and auditing program of hospital performance measures.
In a nationwide population-based cohort study, we identified 14,228 patients admitted to Danish psychiatric departments between 2004 and 2011 and registered in The Danish Schizophrenia Registry. The registry systematically monitors and audits the adherence to clinical guideline recommended processes of care at all Danish psychiatric hospital departments treating patients with schizophrenia.
The overall proportion of all relevant recommended processes of care delivered to the patients increased from 64 % to 76 % between 2004 and 2011. The adherence to a number of individual processes of care increased over time, including assessment of psychopathology using a diagnostic interview (Relative risk (RR) 2.01, 95 % CI: 1.50; 2.69), contact with relatives (RR 1.44, 95 % CI: 1.27; 1.62), psychoeducation (RR 1.33, 95 % CI: 1.18; 1.48), psychiatric aftercare (RR 1.06 95 % CI: 1.01; 1.11) and suicide risk assessment (RR 1.31, 95 % CI: 1.20; 1.43). However, improvements were not observed for all assessed processes of care and substantial variation remained between the hospitals.
Quality of care improved substantially from 2004 to 2011 among patients hospitalized with schizophrenia at Danish hospitals. However, continued efforts to reduce performance variation between hospitals are warranted.
Spouses resemble each other for psychopathology, but data regarding spousal resemblance in externalizing psychopathology, and data regarding spousal resemblance across different syndromes (e.g. anxiety in wives and attention deficit/hyperactivity disorder [ADHD] in husbands) are limited. Moreover, knowledge is lacking regarding spousal resemblance in parents of children with psychiatric disorders. We investigated and compared spousal resemblance within and across internalizing and externalizing symptom domains in parents of children with and without psychopathology.
Symptoms of depression, anxiety, avoidant personality, ADHD, and antisocial personality were assessed with the Adult Self Report in 728 mothers and 544 fathers of 778 children seen in child and adolescent psychiatric outpatient clinics and in 2075 mothers and 1623 fathers of 2784 children from a population-based sample. Differences in symptom scores and spousal correlations between the samples were tested.
Parents in the clinical sample had higher symptom scores than in the population-based sample. In both samples, correlations within and across internalizing and externalizing domains of psychopathology were significant. Importantly, correlations were significantly higher in the clinical sample (P = 0.03). Correlations, within and across symptoms, ranged from 0.14 to 0.30 in the clinical sample and from 0.05 to 0.23 in the population-based sample.
This large study shows that spousal resemblance is not only present within but also across symptom domains. Especially in the clinical sample, ADHD symptoms in fathers and antisocial personality symptoms in mothers were correlated with a range of psychiatric symptoms in their spouses. Clinicians need to be alert of these multiple affected families.