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Drug-induced liver injury (DILI) has a very variable clinical and biochemical phenotype and differs widely in severity, from mild injury to life-threatening liver failure. Chronic injury has also been reported to occur at a variable frequency, ranging from 3.4% to 39%, 6-12 months after discontinuing the implicated agent. This wide range is probably related to various definitions of chronic liver injury and variable selection of patients. The long-term sequalae of this chronic injury in terms of morbidity and mortality are unclear, although rare vanishing bile duct syndrome is associated with an unfavourable prognosis, with increased risk of chronic liver failure and need for liver transplantation. Other forms of long-term sequalae associated with DILI are progressive fibrosis, autoimmune-like hepatitis, secondary sclerosing cholangitis, sinusoidal obstruction syndrome and, as a common final stage, the development of cirrhosis, portal hypertension and its complications. Immune checkpoint inhibitors, which can cause an autoimmune-like phenotype have also recently been shown to cause sclerosing cholangitis with cytotoxic T CD8+ cell infiltration in biliary tracts. DILI has been shown to have a significant impact on health-related quality of life but very little is known about its psychological consequences in the long-term. Further investigations with structured long-term follow-up and periodic quality of life surveys are needed to assess the impact of DILI on psychological outcomes, particularly in those with chronic sequelae. [ABSTRACT FROM AUTHOR]

The purpose of this report is to examine the extent of psychological disability and its impact throughout the lifespan. The report is based on a secondary analysis of the official survey of Psychological Disability by the Australian Bureau of Statistics. Psychological disability encompasses abroad continuum of developmental, cognitive and psychiatric disorders. It affects 3.4 per cent of the population (around 770,000 Australians) and accounts for one-fifth of all persons with a disability. Depression and mood affective disorders are its major components. It does feature as an independent condition but in 88% of cases exists in conjunction with other long-term health factors. This disability increases monotonically across the age groups and rises dramatically from ages 65 and over. The proportion at the extremes of age is moderated by gender. Almost all persons with a psychiatric disability (96.5%) experienced a restriction in their daily living activities or some form of schooling or employment restriction. A tentative framework for the study of psychological disability across the lifespan is introduced. [ABSTRACT FROM AUTHOR]

Psychologists serving as Qualified Medical Examiners (QMEs) in settings where mental and emotional damage claims (i.e., psychological disability stemming from psychological injury) are involved typically must comment not only upon the impact of the injury on the individual's functioning and quality of life, but also on the causality of the psychological disability. This is a highly specialized endeavor for which little guidance exists. The disparate conceptualizations of causality in the fields of psychology and law and the unavoidable complexities associated with determining causality, especially the apportionment of causality across industrial and non-industrial factors, are discussed. The questions at the core of the present paper are: 1) What are the ethical challenges facing psychologists working as QMEs who are tasked with determining causality of psychological disability in the ways currently required by the law, and 2) What considerations should guide ethically-minded psychologists in such settings? The authors argue that, although some level of subjectivity is unavoidable, psychologists working within the legal system can take the lead in bringing an evidence-based approach and greater scientific rigor to the high-stakes causal evaluations required as a basis for determining compensation for injured workers. [ABSTRACT FROM AUTHOR]

Background: Low back pain (LBP) is a common chronic disease causing pain and severe imitations in mobility. Apart from physical impairment, LBP also affects psychosocial functioning in such domains as interpersonal relationships, emotions or everyday-living activities. In Poland there is a relative lack of tools evaluating the psychosocial functional status in patients with LBP. Objective: The objective of the study was to develop and test psychometric properties of a new instrument measuring dimensions of psychosocial functioning in patients with LBP – Psychosocial Functioning Questionnaire (PFQ) for Patients with Low Back Pain. Subjects and methods: 100 subjects with LBP took part in the study and completed the initial version of PFQ. A subgroup of 30 random patients was tested with PFQ again after 72 hours. Results: Factor analysis revealed five factors explaining 43% of the total variance. After deleting items with inadequate psychometric properties, the factors were taken to construct five subscales of PFQ: 1. Distress in interpersonal context; 2. Limitations in everyday functioning; 3. Acceptance of life with the disease; 4. Depressive complaints; and 5. Sense of being disabled. Intercorrelations between the subscales ranged from 0.36 to 0.69 and showed an expected pattern. Internal consistency coefficients for the subscales ranged from 0.86 to 0.89, and test-retest correlations ranged from 0.80 to 0.90. None of the subscales showed statistically significant associations with such sociodemographic variables as age, gender, marital status, place of residence or duration of the disease. Scores of one subscale – Acceptance of life with the disease – differed significantly in subgroups with various educational levels. Conclusions: PFQ is a reliable questionnaire which could be a useful instrument in evaluation of psychosocial functioning in patients with LBP. Further research is needed to assess other psychometric properties of PFQ.

Objective To compare the level of oral health-related quality of life (OHRQoL) between patients receiving clear aligners or fixed appliances within one year of follow-up using Oral Health Impact Profile 14 (OHIP-14), a validated self-administered questionnaire. Materials and methods A single-centered, two-arm parallel-group randomized controlled clinical trial was conducted on 36 adult patients (19 females, 17 males; age range: 18 to 25 years) who had severe crowding and require orthodontic treatment with first premolars extraction. The patients were equally and randomly divided into two groups: The clear aligners (CA) group and the fixed appliances (FA) group. OHRQoL was assessed using the OHIP-14 tool at various times during comprehensive orthodontic therapy: baseline (T0), one week (T1), two weeks (T2), one month (T3), 6 months (T4), and 12 months (T5) after starting the active orthodontic treatment. Mann-Whitney U test or Friedman test were used to detect significant differences. The level of significance was set at 5%.  Results All of the selected patients entered the statistical analysis stage. There were no significant differences between the CA and FA groups for the psychological discomfort, psychological disability, social disability, and handicap (P˃0.05) at almost all assessment times. For the functional limitation, physical pain, physical disability, and the overall score, there were significant differences between the studied groups (P˂0.05), with the FA group having higher mean scores than the CA group in all of the assessment times. Conclusion Patients' treatment with clear aligners has less impact on OHRQoL than those treated using conventional fixed appliances during the first year of treatment., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Jaber et al.)

Abstract: Relationships may influence adjustment to chronic pain conditions such as rheumatoid arthritis (RA). We examined how both marital status and marital adjustment were related to pain, physical disability, and psychological disability in 255 adults with RA. Among married participants (n = 158), better marital adjustment (assessed using the Locke-Wallace Marital Adjustment Scale) was correlated with less pain and physical and psychological disability (all P values < .05). Married participants were divided into distressed (n = 44) and nondistressed (n = 114) subgroups and compared with unmarried participants (n = 97). Controlling for demographics and disease severity, unmarried participants had higher affective pain (P = .009) and higher psychological disability (P = .02) than only the nondistressed married participants, but unmarried participants did not differ from distressed married participants. These findings suggest that being married in itself is not associated with better health in RA but that being in a well-adjusted or nondistressed marriage is linked with less pain and better functioning. Perspective: This study examined relationships of marital status and marital adjustment to pain and physical and psychological disability in RA. Findings underscore the importance of considering not only marital status but also degree of marital adjustment in RA and may inform clinical interventions in this population. [ABSTRACT FROM AUTHOR]

Background Acne vulgaris is a common skin disease that affects patients both physically and mentally. Purpose To examine the prevalence of reported depression in acne patients. Methods Patient information was obtained from a medical claims database and analyzed using the Total Resource Utilization Benchmarks™ process. Benchmarks in this study include: age, gender, co-morbid depression, antidepressant utilization, and acne treatment modality. Depression prevalence in acne patients was compared with general population. Results Depression was two to three times more prevalent in acne patients than in the general population, with a reported 8.8% of acne patients having clinical depression. The majority of cases of depression and antidepressant therapy utilization were observed in acne patients aged 18 and over with the highest percentage in the 36–64 age group. Approximately 65.2% of the acne patient population was female, with twice as many reported to have depression as males (10.6% females vs. 5.3% males). Limitations This analysis included only patients that sought treatment for their acne and had also reported having clinical depression. This may underestimate the total prevalence of acne and associated depression. Conclusions Acne is a disease that affects people of all ages both physically and psychologically. A correlation exists between clinical depression and acne patients, particularly those older than 36. “There is no single disease which causes more psychic trauma and more maladjustment between parents and children, more general insecurity and feelings of inferiority and greater sums of psychic assessment than does acne vulgaris” (Sulzberger, 1948 1 ). [ABSTRACT FROM AUTHOR]

Summary Background Patients with psoriasis may experience significant psychological and social disabilities. Stress or distress are proposed aggravators of the disease process in psoriasis. Preliminary studies to date have suggested that adjunctive psychological therapies may be effective in the clinical management of psoriasis. Objectives To examine whether a 6-week multidisciplinary management approach, the Psoriasis Symptom Management Programme (PSMP) for patients with psoriasis improves clinical severity of psoriasis and its associated psychological distress and disability. Methods In a case–control study, patients with psoriasis attending an out-patient psoriasis speciality clinic chose to receive standard psoriasis treatment alone (n = 53) or to enter the PSMP as an adjunct to standard therapy (n = 40). They were assessed at baseline, at the end of the 6-week PSMP and after 6 months follow-up. Results As compared with standard treatment alone, analysis of covariance indicated that participation in the PSMP resulted in a greater reduction in clinical severity of psoriasis (P = 0·001), anxiety (P = 0·001), depression (P = 0·001), psoriasis-related stress (P = 0·001) and disability (P = 0·04) at 6 weeks and 6 months follow-up. Conclusions The management of the physical aspects of psoriasis and its psychological effects are significantly improved for patients who opt for a 6-week integrated multidisciplinary approach. Furthermore, the techniques learnt by participation in the PSMP facilitate continued control of psoriasis for at least 6 months. [ABSTRACT FROM AUTHOR]

We have developed, tested and validated a new scoring system for psoriasis: the Salford Psoriasis Index (SPI). The SPI incorporates the current clinical extent of psoriasis based on the Psoriasis Area and Severity Index (PASI), a score indicating psychosocial disability, and past severity based on treatment history. The resultant three-figure SPI (signs, psychosocial disability, interventions) is a similar paradigm to the TNM (tumour, nodes, metastasis) classification used for cancer staging. The first figure transforms the PASI into a number from 0 to 10 reflecting extent of psoriasis. The second assesses the psychosocial impact of psoriasis on each patient using a 0–10 visual analogue scale. The third figure reflects historical severity of disease as judged by the need for systemic treatment, admission to hospital and number of episodes of erythroderma. The SPI was prospectively employed in assessing 150 consecutive patients with psoriasis. Furthermore, in a separate cohort of 100 patients we tested the Psychosocial Impact Score against a recognized self-report psoriasis-specific measure, the Psoriasis Disability Index. There was a strong correlation between the two (r = 0·59, P < 0·001). However, the Psychosocial Impact Score correlated poorly with clinical extent scores such as the PASI (r = 0·28, P < 0·05) and the Self-administered PASI in 72 patients tested (r = 0·19, P = 0·1). There was a high correlation between all six observers in 20 patients for both PASI (r = 0·71; 95% confidence interval, CI 0·51–0·86) and the Extent Score (r = 0·70; 95% CI 0·56–0·89). We believe that the SPI will be more relevant to real-life categorization of psoriasis severity in that it takes an holistic approach based not only on physician assessment but also psychological disability and treatment resistance. [ABSTRACT FROM AUTHOR]

Background Wearing fixed orthodontic appliances may negatively impact oral health-related quality of life (OHRQoL) during treatment. This study aimed to compare the OHRQoL of patients treated with labial or lingual appliances. Methodology A total of 38 patients (23 females, 15 males; mean age: 21.3 years) with class I malocclusion and moderate crowding in the upper and lower dental arches were included. These patients were planned to be treated on a non-extraction basis and were randomly divided into the following two groups: the lingual appliance (LA) group and the buccal appliance (BA) group. The Oral Health Impact Profile-14 (OHIP-14) questionnaire was used to measure the OHRQoL at the following six assessment times: before treatment (T0), one week after treatment (T1), one month after treatment (T2), three months after treatment (T3), six months after treatment (T4), and at the end of the active treatment (T5). Results In total, 19 patients in each group were included in the final analysis with no dropouts. In both groups, the overall OHIP-14 scores increased and peaked on the first week following appliance placement and then significantly decreased over time. The LA group had significantly greater overall OHIP‑14 scores than the labial group at T1 (p < 0.001) and T2 (p = 0.004) only. Conclusions The OHRQoL improved in both lingual and labial groups after treatment. Moreover, it was better in the labial group compared to the lingual group during the first month of treatment. In both groups, the greatest deterioration in OHRQoL occurred in the first week and gradually decreased over time., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Kara-Boulad et al.)

I examine and challenge the view, expressed by some literary theorists, that writings about trauma should be read and taught differently from other writings because these reflect a desire to heal with the support of a community of readers. I explore some poems about incest, including my own, and the expressed intentions and intellectual processes of the authors. I argue that framing these writings as healing narratives misconceives the writers as healers. I address some challenges in teaching incest narratives and strategies that can help ensure the inclusion of student incest survivors and, generally, student survivors of chronic childhood trauma. While some scholars have emphasized the importance of instructors providing trigger warnings when assigning material about trauma, students of chronic childhood trauma can be triggered by wide-ranging material. I emphasize that these students need to be recognized as a minority group facing disadvantages and discrimination, and discuss how educational institutes and campus services could be improved to better meet their needs. Further, I elaborate how survivor-inclusive pedagogy gives a central place in diverse curricula to first-person narratives and experiences of survivors. Finally, I note some encouraging developments in the fields of psychology and law and make some recommendations. [ABSTRACT FROM AUTHOR]