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The Art of Child and Adolescent Psychiatry is an engaging and authoritative account of the essential skills required to practice child and adolescent psychiatry for all those working in children's mental health, from trainees to experienced professionals in paediatrics, psychiatry, psychology, and psychotherapy. The practical tasks of meeting the child and family, planning treatments, and working with colleagues are all covered, building on existing texts that mainly focus on diagnostic criteria, protocols, and laws. This book respects the evidence base, while also pointing out its limitations, and suggests ways in which to deal with these. Psychiatry is placed within broader frameworks including strategy, learning, management, philosophy, ethics, and interpersonal relations. With over 200 educational vignettes of the authors' vast experience in the field, the book is also highly illustrated. The Art of Child and Adolescent Psychiatry is an indispensable guide to thoughtful practice in children's mental health.
The coronavirus disease-2019 (COVID-19) pandemic has caused myriad health, social, and economic stressors. To date, however, no known study has examined changes in mental health during the pandemic in the U.S. military veteran population.
Data were analyzed from the 2019–2020 National Health and Resilience in Veterans Study, a nationally representative, prospective cohort survey of 3078 veterans. Pre-to-peri-pandemic changes in psychiatric symptoms were evaluated, as well as pre-pandemic risk and protective factors and pandemic-related correlates of increased psychiatric distress.
The prevalence of generalized anxiety disorder (GAD) positive screens increased from pre- to peri-pandemic (7.1% to 9.4%; p < 0.001) and was driven by an increase among veterans aged 45–64 years (8.2% to 13.5%; p < 0.001), but the prevalence of major depressive disorder and posttraumatic stress disorder positive screens remained stable. Using a continuous measure of psychiatric distress, an estimated 13.2% of veterans reported a clinically meaningful pre-to-peri-pandemic increase in distress (mean = 1.1 standard deviation). Veterans with a larger pre-pandemic social network size and secure attachment style were less likely to experience increased distress, whereas veterans reporting more pre-pandemic loneliness were more likely to experience increased distress. Concerns about pandemic-related social losses, mental health COVID-19 effects, and housing stability during the pandemic were associated with increased distress, over-and-above pre-pandemic factors.
Although most U.S. veterans showed resilience to mental health problems nearly 1 year into the pandemic, the prevalence of GAD positive screens increased, particularly among middle-aged veterans, and one of seven veterans experienced increased distress. Clinical implications of these findings are discussed.
Our understanding of major depression is complicated by substantial heterogeneity in disease presentation, which can be disentangled by data-driven analyses of depressive symptom dimensions. We aimed to determine the clinical portrait of such symptom dimensions among individuals in the community.
This cross-sectional study consisted of 25 261 self-reported White UK Biobank participants with major depression. Nine questions from the UK Biobank Mental Health Questionnaire encompassing depressive symptoms were decomposed into underlying factors or ‘symptom dimensions’ via factor analysis, which were then tested for association with psychiatric diagnoses and polygenic risk scores for major depressive disorder (MDD), bipolar disorder and schizophrenia. Replication was performed among 655 self-reported non-White participants, across sexes, and among 7190 individuals with an ICD-10 code for MDD from linked inpatient or primary care records.
Four broad symptom dimensions were identified, encompassing negative cognition, functional impairment, insomnia and atypical symptoms. These dimensions replicated across ancestries, sexes and individuals with inpatient or primary care MDD diagnoses, and were also consistent among 43 090 self-reported White participants with undiagnosed self-reported depression. Every dimension was associated with increased risk of nearly every psychiatric diagnosis and polygenic risk score. However, while certain psychiatric diagnoses were disproportionately associated with specific symptom dimensions, the three polygenic risk scores did not show the same specificity of associations.
An analysis of questionnaire data from a large community-based cohort reveals four replicable symptom dimensions of depression with distinct clinical, but not genetic, correlates.
The Eating Assessment in Toddlers FFQ (EAT FFQ) has been shown to have good reliability and comparative validity for ranking nutrient intakes in young children. With the addition of food items (n 4), we aimed to re-assess the validity of the EAT FFQ and estimate calibration factors in a sub-sample of children (n 97) participating in the Growing Up Milk – Lite (GUMLi) randomised control trial (2015–2017). Participants completed the ninety-nine-item GUMLi EAT FFQ and record-assisted 24-h recalls (24HR) on two occasions. Energy and nutrient intakes were assessed at months 9 and 12 post-randomisation and calibration factors calculated to determine predicted estimates from the GUMLi EAT FFQ. Validity was assessed using Pearson correlation coefficients, weighted kappa (κ) and exact quartile categorisation. Calibration was calculated using linear regression models on 24HR, adjusted for sex and treatment group. Nutrient intakes were significantly correlated between the GUMLi EAT FFQ and 24HR at both time points. Energy-adjusted, de-attenuated Pearson correlations ranged from 0·3 (fibre) to 0·8 (Fe) at 9 months and from 0·3 (Ca) to 0·7 (Fe) at 12 months. Weighted κ for the quartiles ranged from 0·2 (Zn) to 0·6 (Fe) at 9 months and from 0·1 (total fat) to 0·5 (Fe) at 12 months. Exact agreement ranged from 30 to 74 %. Calibration factors predicted up to 56 % of the variation in the 24HR at 9 months and 44 % at 12 months. The GUMLi EAT FFQ remained a useful tool for ranking nutrient intakes with similar estimated validity compared with other FFQ used in children under 2 years.
This article addresses the question of the geographical scope of the ‘age of revolutions’ (c.1750–1850) through the case of a peasant uprising in Mount Lebanon in 1821. This uprising had similarities with recent and contemporary revolutions and rebellions, which have led some to suggest the influence of the ideas of the French Revolution of 1789 or the Greek Revolution of 1821. This article argues that influence at the level of ideas was unimportant, but that the similarities can plausibly be traced to similar and connected contexts at the level of political economy, as the expansion and crisis of military-fiscal states provoked opposition ‘from below’ and renegotiations of sovereignty. This focus on political economy rather than genealogies of ideas can then help define an ‘age of revolutions’ extending beyond Europe and the north Atlantic into the Ottoman empire, Latin America, and other regions.
In 1898, Muḥammad al-Muwayliḥī began the serial publication of what would become his ironic masterpiece Ḥadīth ʿĪsā ibn Hishām (ʿĪsā ibn Hishām’s Tale). Its major premise was the miraculous return from the dead, in 1890s Cairo, of one of the great men of Mehmed Ali’s time. In real life he was Ahmad Manikli Pasha (c. 1795–1862), general of the Syrian campaigns and Minister of War in the 1830s, governor of the Sudan in the 1840s (where he earned a reputation for brutality for his subjugation of the Hadandawa Beja tribes), commander of the Egyptian division in the Crimean War in the 1850s. Autocratic, Ottoman-speaking, pious after his fashion, Muwayliḥī’s resurrected Pasha finds himself at a loss in the new Cairo of the turn of the twentieth century, despite the best efforts of his guide, theʿĪsā ibn Hishām of the title. The lower classes are insubordinate, the police and legal system corrupt and chaotic, the language of administration Europeanised and incomprehensible, the sons of the old elite and nouveaux riches alike given over to wine and women, and to gambling – both in nightclubs and on the stock exchange. A volatile financialised economy, the glaring presence of Europeans and European-style culture and the ever-present shadow of the British occupation contribute to the febrile atmosphere of fin de siècle decadence and insecurity. In certain scenes, as when the Pasha encounters the sons of his former comrades of Mehmed Ali’s days, we are left with the strong impression of a once-great ruling class that has lost both its moral compass and its power.
One of the major changes in consciousness brought about by the movement which became known as the ‘Nahda’ was in Arab intellectuals’ perception of their place, and that of their countries and societies, within the world. This is often reduced to the question of their changing relationship with Europe – with some justification, for it was with Europe that they had the most intense and sustained contacts, and through Europe that they initially derived much of their knowledge of the world beyond. But the abundant evidence for their knowledge of, and interest in, the non-European world outside their own lands requires, it seems to me, a restatement of the question. They needed to locate themselves within a new picture of the world, one dominated by Europe and often seen by them through European eyes, but not in fact reducible to the continent of Europe itself.
What was Khūrī thinking of, when he announced the birth of a new era in Beirut, in Ottoman-ruled Syria, in 1858? He might have been thinking of the astonishing growth of the port city of Beirut itself over the past three decades. From being a small backwater on the coast below Mount Lebanon, the city had become the main port of Syria, a major regional entrepot with regular steamship sailings to Europe and Egypt. He might have thought particularly of the rise to prosperity of Beirut’s local merchants – Syrian Christians, Muslims and Jews, selling, notably, Lebanese silk in exchange for European manufactured goods. Indeed, one such merchant, the wealthy and cultured Mīkhāʾīl Mudawwar, was financing his paper. Or he might have had in mind recent political changes. In 1856 the Ottoman government had issued the Hatt-ı Hümayun reform decree, promising equality to all the religions of the Empire – and also heralding the Tanzimat programme of reforms. These would bring a greatly expanded bureaucracy, which Khūrī and other Syrians like him would join, new laws favourable to commercial development and an extension of state power into areas of life it had previously hardly touched. Ottoman Syria would have seemed – from the perspective of a comfortable man of letters in Beirut – well on its way to economic prosperity and political order, a context in which Khūrī, other intellectuals like him and their wealthy merchant patrons could flourish. The universe was ordering itself around them, by a benevolent design.
Who made the Nahda? What social groups were involved in producing and supporting it? In what relation did these groups stand to other groups in their society, and to the wider historical processes that defined their era? These questions have not always been clearly posed in literary or intellectual histories of the Nahda, either in Arabic or in European languages. I do not aim to present here a comprehensive answer, or to survey all those who engaged in or supported Nahda cultural enterprises. Instead, I will examine in detail three clusters of particularly important Nahda literati. One emerged in Cairo in the 1830s and 1840s, in the Languages School run by Rifāʿa al-Ṭahṭāwī. A second took shape in the cultural societies of Beirut from the 1840s to the 1860s. The third arose in literary circles among Catholics in Aleppo in the 1850s and 1860s. It was individual members of these three clusters who produced the Nahda texts I analyse in detail in Chapters 2–4. The bulk of the present chapter is devoted, though, to examining each one of the clusters themselves, as a collectivity, or more precisely as what Raymond Williams calls a cultural ‘formation’: at once a circle of people, a set of cultural tendencies or practices, and – in some cases – a group of formal cultural institutions, such as schools, presses or learned societies. In each case, I will examine in detail who their members were, how they interacted with each other and what particular cultural practices they created or adapted to their needs.
This chapter addresses the forms taken by utopian thinking and writing in the Nahda. It first examines the notion of ‘utopia’ and its parallels in older Arabic traditions, and then its relevance to parts of the Beiruti and Cairene Nahda already examined. Next it presents a detailed study of the Aleppine writer Fransīs Marrāsh’s remarkable utopian narrative Ghābat al-Ḥaqq; and, finally, turns to Marrāsh’s later work of the early 1870s, to consider how utopian impulses could lead to a sharp critique of the Nahda’s civilising projects.
Our first chapter has considered the cultural movement of the Nahda – or its distinct component formations, in Bilād al-Shām and Egypt – from a largely external point of view, in an attempt to ‘place’ it socially and historically. The remainder of this study will consider it to a far greater extent from an ‘internal’ aspect, by examining in detail some of the movement’s actual intellectual and creative production. I will turn first to the Beiruti ‘formation’ in the 1850s and 1860s, and concentrate on what seems to me probably the most crucial contribution of the Beiruti intellectuals in these decades. This is the discourse and vocabulary centred around the concept of ‘civilisation’, which may be seen as growing to maturity in this time and place – in conjunction with the literary forms in which it was expressed. It was to a large extent through this discourse that the Arab Nahda writers through the latter half of the nineteenth century and beyond would attempt to comprehend, come to terms with, celebrate or resist the forces that were changing their world.
The background conditions for the emergence of the rule of law are important but underdeveloped. This paper discusses current theories of the origin of the rule of law, arguing that they are useful but incomplete. In addition to those theories, the Jewish and Christian concept of all human beings as God's image bearers is an important contributor to the rule of law in Western civilization. The formulation of universal human equality is not, however, a sufficient condition for the emergence of the rule of law. The concept has taken centuries of articulation in different institutions and social settings. It only reached full fruition when it was joined with an understanding of appropriate legal and political systems as expressed by political theorists such as Locke, Montesquieu, and Madison.
Exploring the 'Nahda', a cultural renaissance in the Arab world responding to massive social change, this study presents a crucial and often overlooked part of the Arab world's encounter with global capitalist modernity, an interaction which reshaped the Middle East over the course of the long nineteenth century. Seeing themselves as part of an expanding capitalist civilization, Arab intellectuals approached the changing world of the mid-nineteenth century with confidence and optimism, imagining utopian futures for their own civilizing projects. By analyzing the works of crucial writers of the period, including Butrus al-Bustani and Rifa'a al-Tahtawi, alongside lesser-known figures such as the prolific journalist Khalil al-Khuri and the utopian visionary Fransis Marrash of Aleppo, Peter Hill places these visions within the context of their local class- and state-building projects in Ottoman Syria and Egypt, which themselves formed part of a global age of capital. By illuminating this little-studied early period of the Arab Nahda movement, Hill places the transformation of the Arab region within the context of world history, inviting us to look beyond the well-worn categories of 'traditional' versus 'modern'.