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Borderline personality disorder is a severe disorder with distinct features which might be early identified in adolescence. Adverse experiences in childhood have been established as a risk factor f...

Background The present study aims to characterize knowledge, attitudes and practices in a sample of general practitioners (GPs) on management of travelers’ diarrhea (TD). Methods A total of 158 GPs (44.3% males; mean age 40.2 ± 12.4 years) completed a web questionnaire on antibiotic prophylaxis (AP) and/or an antibiotic treatment (AT) in TD cases. Participants were inquired on knowledge status (KS), risk perception and effectively applied recommendations for AP/AT through a specifically designed questionnaire. Multivariate odds ratios (OR) for predictors of AP/AT were calculated through regression analysis. Results All in all, while 15 (9.5%) participants recommended AP for TD, 61 of them (39.4%) recommended AT. KS was largely unsatisfying as participants extensively ignored the most recent AP/AT recommendations. Acknowledgment of TD as a severe disorder was predictive for recommendation of AP (OR 37.843, 95% CI 4.752–301.4). As for AT, it was relatively elevated in GPs ≥ 10 years (OR 2.653, 95% CI 1.169–6.019), but more rarely reported in participants with higher KS (OR 0.056, 95% CI 0.021–0.153). Conclusions Adherence of GPs to official recommendations for TD management was unsatisfying, particularly in older participants. Continuous Education of GPs should be improved by sharing up-to-date official recommendations on AT/AP for TD.

Attention-deficit/hyperactivity disorder (ADHD), Oppositional Defiant Disorder (ODD), and Conduct Disorder (CD) are highly comorbid, with symptoms that share some similarities. The evidence-based diagnostic process for these disorders includes ratings from adults in the child’s life to assess behavior across settings, so it is important to understand how these raters think about potentially overlapping symptoms. Researchers have identified negative halo effects in ratings of ADHD and ODD symptoms, but ratings of CD have not been examined in these prior studies. Thus, the current study extended past research to examine negative halo effects in parent ratings of the predominantly hyperactive-impulsive presentation of ADHD (i.e., ADHD/HI), ODD, and CD. Parent participants read one of four vignettes that portrayed an 11-year-old boy displaying symptoms of ADHD/HI, ODD, CD, or typical development, and then completed a disruptive behavior scale. The general trend we found was that the presence of a relatively more severe disorder (i.e., CD) artificially inflated ratings of - or showed a negative halo effect for - the relatively less severe disorder (i.e., ADHD/HI), but with some nuance as discussed in the paper. These findings explain and validate how important it is that clinicians conduct evidence-based psychological assessments to decrease the chance of misdiagnosis.

Structural disorder within grains formed by carbon doping is widely known to enhance the in-field transport critical current performance of MgB2 wire. The structural formation usually requires high-temperature sintering above 600 °C due to low reactivity of the dopant. In this study, we selected a carbohydrate (malic acid) that has a low-decomposition temperature as the carbon dopant and performed low-temperature sintering (below 600 °C) to introduce greater disorder within the MgB2 grains. We revealed that the doping and low-temperature sintering process cause severe disorder, especially along the out-of-plane (c-axis) direction. The disordered formation, in addition to the in-plane disorder combined with well-connected grains, eventually raised the in-field transport performance.

Objetivos: Describir los trastornos temporomandibulares, más prevalentes, según el índice de Helkimo en los estudiantes de la Universidad Privada de Huancayo Franklin Roosevelt, evaluados a inicio del semestre académico 2018-I. Material y Métodos: Se usó como método general, el científico y como específico, el observacional. Tipo de investigación básica, diseño descriptivo simple. La población fue de 2276 estudiantes del I al X ciclo de ambos sexos y matriculados en sus respectivos ciclos, pertenecientes de las escuelas profesionales de la Universidad Privada de Huancayo Franklin Roosevelt. La muestra fue 329 estudiantes seleccionados con muestreo probabilístico estratificado. La recolección de datos se realizó a través de la técnica de observación y el instrumento la ficha clínica a través del test de Helkimmo. Los métodos que se utilizaron para el análisis y procesamiento de los datos fue a través del software SPSS V 20 y Excel 2010. Resultados: Los resultados se presentaron en cuadros, tablas y gráficos de frecuencias y porcentajes. Se evidenció que el “trastorno moderado” alcanzó el 55,9% de la muestra, el “trastorno severo grado I” alcanzó el 38,9%, con “función normal” el 2,4%, “trastorno severo grado III” el 1,2%, “trastorno severo grado II el 0,9% y trastorno leve el 0,6%. Conclusiones: Se ha encontrado en la detección de los trastornos temporomandibulares, que el “trastorno moderado” es el más prevalente con el 55,9% de la muestra, seguido del “trastorno severo grado I” con un 38,9%, en los estudiantes de la universidad privada de Huancayo Franklin Roosevelt, evaluados en el semestre académico 2018-I, con el test de Helkimo.

Genetic heterogeneity leading to retinal disorders impairs biological processes by causing, for example, severe disorder of signal transduction in photoreceptor outer segments. A normal balance of ...

The present study aimed at studying the spatial–temporal behavior of precipitation received over a long period of time in the northern strip in Iran. To this end, the available data related to the precipitation in the 50 years (1957–2007) were extracted from APHRODITE with a spatial resolution of 0.25° × 0.25°. Some statistical analyses such as dispersion statistics and the analysis of trend were run on the extracted data to obtain the precipitation changes in a decade, using MATLAB software. The results of the analyses showed that the precipitation changes in decade in the northern strip in Iran followed a high clustering pattern due to the physiography of the region, convection and the influence of weather systems, and over time, precipitation is concentrated in this region of the north of Iran. Statistical analyses showed that precipitation pattern had a severe disorder. The simulation of the precipitation density function also showed a decrease in precipitation variance and a sharpening of the Gaussian function, indicating the absence of constant precipitation conditions in the northern strip of the country. Moreover, the assessment of trends through non-parametric method showed that the annual precipitation has a decreasing trend in the region. Analysis of the daily precipitation concentration demonstrated a widespread distribution, and, confirmed the irregularity and inequality of daily precipitation across the northern strip of Iran.

The crystalline sponge method (CSM) is primarily used for structural determination by single-crystal X-ray diffraction of a single analyte encapsulated inside a porous MOF. As the host-guest systems often show severe disorder, reliable crystallographic determination is demanding; thus the dynamics of the guest entering and the formation of nanoconfined molecular aggregates has not been in the spotlight. Now, the concept is investigated of the CSM for monitoring the structural evolution of nanoconfined supramolecular aggregates of eugenol guests with displacement of DMF inside the cavities of the flexible MOF, PUM168. The interpretation of the electron density provides a series of unique detailed snapshots depicting the supramolecular guest aggregation, thus showing the tight interplay between the host flexible skeleton and the molecular guests through the DMF-to-eugenol exchange process.

Arterial ischemic stroke in children is a severe disorder with significant morbidity and mortality. Urgent diagnosis is mandatory in order to save lives or minimize neurological sequelae. However, recognition of stroke in children is more difficult than in adults. Barriers such as low suspicion, diverse risk factors, difficulties performing neuroimages, and a lack of protocols for diagnosis and treatment make stroke management in children a challenge. This article aims to review the approach to arterial stroke in children. Recently, more focus has been placed in the development of comprehensive stroke centers for treatment of stroke in children. Shortening time for diagnosis allows initiating a prompt and successful hyperacute treatment. Neuroprotection must be initiated before diagnosis confirmation. As in adult patients, widening the thrombolytic treatment time window and optimizing secondary stroke prevention are main points to develop. Early decompressive hemicraniectomy in children with malignant infarct should be considered. A multidisciplinary team is necessary for the diagnosis and treatment of children with brain attack. A particular “stroke code” must be established in each institution for stroke management and evidence-based guidelines should be developed.

Background Initial clinical manifestations of NMOSD may rarely overlap with MS. Fingolimod may trigger severe attacks in patients with NMOSD previously misdiagnosed as MS. These cases are rare and their pathophysiology remains elusive. Methods We recruited all NMOSD patients treated by fingolimod in a single-center cohort of Afro-Caribbean neuro-inflammatory patients in Fort-de-France (French West Indies). Six patients were collected from the literature. Results Among 622 patients followed locally for MS, 101 received fingolimod and two suffered severe attacks revealing a typical NMOSD presentation. These two patients were found to have AQP4-IgG. The risk of misdiagnosed NMOSD in MS in our high-risk Afro-Caribbean patients was estimated to be 1.9% (0 to 4.7%). Among the whole cohort, relapses occurred within a month after fingolimod initiation in five patients. All attacks were severe and contrasted with previously benign attacks, suggesting a shift to a more severe disorder. An unusual finding in these patients was large brain lesions. Conclusion AQP4-IgG should be obtained before initiation of fingolimod in high-risk patients, especially in those from areas of high NMOSD prevalence.

Obstructive sleep-disordered breathing (OSDB) is a spectrum of entities with variable severity ranging from primary snoring to obstructive sleep apnea (OSA). OSA is usually considered to be the most severe disorder of the OSDB spectrum. Children with OSA experience partial or complete obstruction of the upper airways during sleep, which may result in arousals and/or awakenings from sleep. Polysomographic findings frequently include snoring, significant changes in airflow associated with frequent electroencephalographic (EEG) arousals and awakenings from sleep, periodic changes in oxygen saturation level, and elevation of carbon dioxide level. Obstructive and partially obstructive events (obstructive apneas and obstructive hypopneas, respectively) are frequently associated with an increase in respiratory effort registered by chest and abdominal belts as well as intercostal electromyogram (EMG).

The herniation of cerebellum through the foramen magnum may block the normal flow of cerebrospinal fluid determining a severe disorder called Chiari I Malformation (CM-I). Different surgical options are available to help patients, but there is no standard to select the optimal treatment. This paper proposes a fully automated method to select the optimal intervention. It is based on morphological parameters of the brain, posterior fossa and cerebellum, estimated by processing sagittal magnetic resonance images (MRI). The processing algorithm is based on a non-rigid registration by a balanced multi-image generalization of demons method. Moreover, a post-processing based on active contour was used to improve the estimation of cerebellar hernia. This method allowed to delineate the boundaries of the regions of interest with a percentage of agreement with the delineation of an expert of about 85%. Different features characterizing the estimated regions were then extracted and used to develop a classifier to identify the optimal surgical treatment. Classification accuracy on a database of 50 patients was about 92%, with a predictive value of 88% (tested with a leave-one-out approach).

This Article is dedicated to researching the issue of female criminality, and namely, to conducting forensic expert evaluations of ability of women who committed violent crimes to realize the significance or their actions and (or) manage such actions. We present the results of analysis of 169 conclusions of forensic psychiatric expert evaluations and comprehensive forensic psychologic and psychiatric expert evaluations within criminal proceedings involving the mentioned category of persons (for the period of 2010-2016). This analysis has allowed to highlight typical mistakes in assigning forensic expert evaluations in various categories of crimes, including the crimes where the offender is dependent on the object of a criminal act. This article cites a structured medical criterion for incompetence or limited competence of mentioned females at the time of delict (based on the researched subjects). The structure of the medical criterion for incompetence includes mental disorders that annihilate the ability of a person to stay aware of her actions and manage such actions at the time of a criminal act due to psychotic symptoms and/or severe disorder of the behavior-regulating intellectual component. Meanwhile, the structure of the medical criterion for limited incompetence included cases where females were not capable of fully realizing their actions (or lack of thereof) and manage such actions due to explicit behavioral disorders. Such cases envisage that possible intellectual disorders were offset specifically by explicit disturbance of emotions and volition. It was discovered that despite females having mental disorders of varying origin and degree of severity (expert evaluations conducted in 2010-2016), only a small percentage of these women were considered “incompetent/of limited competency” based on the medical criterion. Taking this into account as well as severity of a delict, research of the psychological criterion of competence highlights, first and foremost, psychological peculiarities of female criminals and analysis of a crime situation. Based on the above-mentioned, we have defined the necessity of different approaches and opinions among psychologists (as forensic experts and psychodiagnostics experts) during expert evaluations depending on the object of a criminal act. In addition, in the course of a psychological expert evaluation of ability to be aware of one’s actions and manage such actions during a crime explicitly directed against life and health of a person, we shall necessitate a body of grounded evidence of presence or absence of not only a physiological affective state, but also other emotional states (frustrations, tension) at the time of a crime, while noting their possible influence on awareness and actions of a person at the moment of delict.

Detection of proteins which may be potential biomarkers of disorders represents a big step forward in understanding the molecular mechanisms that underlie pathological processes. In this context proteomics plays the important role of opening a path for the identification of molecular signatures that can potentially assist in early diagnosis of several clinical disturbances. Aim of this report is to provide an overview of the wide variety of proteomic strategies that have been applied to the investigation of chronic obstructive pulmonary disease (COPD), a severe disorder that causes an irreversible damage to the lungs and for which there is no cure yet. The results in this area published over the past decade show that proteomics indeed has the ability of monitoring alterations in expression profiles of proteins from fluids/tissues of patients affected by COPD and healthy controls. However, these data also suggest that proteomics, while being an attractive tool for the identification of novel pathological mediators of COPD, remains a technique mainly generated and developed in research laboratories. Great efforts dedicated to the validation of these biological signatures will result in the proof of their clinical utility.

Idiopathic pulmonary fibrosis is a severe disorder mainly affecting lungs. It occurs more frequently in smokers or former smokers with an average age of onset around 65. The first pathogenetic event leading to the complete derangement of lung parenchyma is the alveolar stem cell exhaustion due to intrinsic factors (genetic mutations or polymorphisms) and extrinsic insults (cigarette smoke, pollution). The histopathologic background is Usual Interstitial Pneumonitis. Transbronchial cryobiopsy allows harvesting of lung samples large enough to identify the characteristic of this morphologic pattern. The best strategy to maintain a high diagnostic yield is to biopsy at least two different segments.

Crack cocaine (crack) dependence is a severe disorder associated with considerable morbidity and mortality, constituting a major public health problem in Brazil. The aim of this study was to improve understanding of the profile of treatment-seeking crack-dependent individuals. We recruited 65 crack-dependent individuals from among those seeking treatment at an outpatient clinic for alcohol and drug treatment in the city of São Paulo, Brazil. Assessments, conducted between August 2012 and July 2014, focused on sociodemographic characteristics, the pattern/history of crack use, treatment history, concomitant substance use disorders, psychiatric symptomatology, and impulsivity. In the study sample, males predominated, as did unemployment, homelessness, and low levels of education. On average, the participants had smoked crack for 10 years. Most had previously been treated for crack dependence. Concomitant DSM-IV diagnoses of dependence on other substances were common, dependence on tobacco and alcohol being the most prevalent. Participants presented significant psychiatric symptomatology and impulsivity, with nearly half of the sample presenting psychotic symptoms, 90% presenting depressive symptoms, and 80% presenting anxiety symptoms. Most treatment-seeking crack-dependent individuals in Brazil are living in extremely poor social conditions and are struggling with the severe, chronic, and comorbid features of this disorder.

The clinical case demonstrates the cure of pulmonary tuberculosis with multiple drug resistance and massive bilateral cavities in a female patient of 31 years old with a severe disorder of pulmonary ventilation of the mixed type, hypoxemic respiratory failure, post-tuberculosis bullous changes in both lungs. Treatment lasted for 4 years. Treatment included anti-tuberculosis chemotherapy, artificial pneumoperitoneum, three endobronchial valves in the bronchi for draining of massive cavities and extrapleural sealing with silicon plug.

Background The aim of this study was to investigate the rate of post-traumatic stress disorder (PTSD) and associated risk factors among mothers whose children underwent oncological surgery. Method This cross-sectional, multi-center study included a total of 60 mothers whose children underwent major thoracoabdominal surgery and were under the follow-up in the outpatient setting between February 2016 and May 2016. Clinical Data Form, Hospital Anxiety and Depression Scale (HADS), and Clinician-Administered PTSD scale (CAPS) were used. Results Of all participants, 13 (21.7%) were diagnosed with PTSD. These mothers had shorter duration of marriage, longer duration of hospital stay after surgery, and higher HADS scores, compared to the others without PTSD. A thoughts of guilt such as “I am being punished or tested” was more frequent among mothers with PTSD. Insomnia, irritability, concentration problems, and psychological reactivity were the most common symptoms. Conclusion PTSD is a severe disorder which may deteriorate the daily functioning of mothers and may also have an unfavorable effect on child. Therefore, it is of utmost importance for clinicians to recognize PTSD and associated risk factors to guide these parents. This article is protected by copyright. All rights reserved.

Confusion and delirium are the most common behavioural disorders seen in emergency departments and acute medical or surgical units. Delirium can be regarded as the new ‘cognitive superbug’. Confusion can be seen as a mild form of delirium and can give warning of the development of the more severe disorder. It causes an acute change of mental status characterized by abnormal and fluctuating attention. It affects 10–30% of medically ill patients, especially elderly individuals and often shortly after hospital admission. It causes prolonged admission, increased morbidity and mortality, and delayed discharge, often culminating in long-term care. Its causation is reviewed and its prevention and management are described.

Background/Aim: The McCune-Albright syndrome (MAS) is a potentially severe disorder hallmarked by fibrous bone dysplasia, café-au-lait skin spots, and endocrine hyperfunction. It is caused by postzygotic activating mutations at the R201 codon of the GNAS gene, leading to a state of somatic mosaicism. Our aim was to improve the mutation detection rate and to quantify the presence of R201 GNAS mutations in different DNA samples from MAS patients. Methods: Real-time COLD- and MAMA-PCR TaqMan techniques were combined to search for R201 mutations in the DNA of blood or affected tissues from 16 previously molecularly characterized MAS patients, from a further 84 subjects with MAS signs who were R201 negative at RFLP analysis, and from 36 controls. The ability of this new method to provide quantitative data was tested in the serial dilution of wild-type, R201H, or R201C cloned plasmid DNA samples; the mutant abundance was measured by spectrophotometry. Results: A linear correlation between the true and the relative mutant abundance was observed until 2.5%, indicating a reliable quantification of R201 mutations. The assay’s sensitivity was 0.05%, similar to that of previously described molecular methods. Conclusion: The real-time COLD-MAMA-PCR approach is a rapid, efficient, and inexpensive molecular technique for the identification of mutant alleles poorly represented in DNA samples.

Treatment restores immune-system function in young children with severe disorder. Treatment restores immune-system function in young children with severe disorder.

Aim Depression is a severe disorder that has enormous consequences for the individual’s quality of life, and it is among the most prevalent forms of mental illness. Saffron, a famous herb medicine ...

Background: Depression is a prevalent and severe disorder and a major cause for attempted and completed suicides in Europe. Objectives: The community-based 4-level-intervention concept developed within the “European Alliance against Depression” (EAAD; www.eaad.net ) combines two important objectives: to improve the care and treatment of patients with depression and to prevent suicidal behavior. Methods: The EAAD community-based 4-level intervention comprises training and support of primary care providers (level 1), a professional public awareness campaign (level 2), training of community facilitators (teachers, priests, geriatric care givers, pharmacists, journalists) (level 3), and support for self-help of persons suffering from depression and for their relatives (level 4). Results: Several studies evaluated different aspects of the 4-level community-based intervention concept over the past years and showed a significant reduction in suicidal behavior and various changes in intermediate outcomes (e.g. changes in attitude or knowledge in different populations). Systematic process evaluation was helpful to identify several predictable and unpredictable obstacles to a successful implementation of such community-based programs as well as synergistic and catalytic effects. Conclusions: The EAAD community-based intervention has been shown to be effective concerning the prevention of suicidal behavior and is the most broadly implemented community-based intervention targeting depression and suicidal behavior world-wide. Via the EAAD and partners from currently 22 countries from in- and outside of Europe, the intervention concept and materials (available in many different languages ) are offered to interested regions.

Mental illness identity deflection refers to rebuffing the idea that one is mentally ill. Predictors of identity deflection and its consequences for well-being were examined for individuals with mental disorders in the National Comorbidity Study–Replication ( N = 1,368). Respondents more often deflected a mental illness identity if they had a nonsevere disorder, had low impairment in functioning, had no treatment experience, viewed possible treatment as undesirable, and held multiple social roles, consistent with theory about stigma resistance. Persons who deflected a mental illness identity had lower distress and more positive affect than those who accepted it, even net of disorder severity, impairment level, and treatment experience. Among those who had ever been in treatment, deflection buffered the negative effects of serious impairment but exacerbated the effects of having a severe disorder on well-being, suggesting more complex consequences of formal labeling (greater stigma but helpful services), consistent with previous research.

OBJECTIVE: To compare the clinical presentation of children with anorexia nervosa (AN group) with that of children with low-weight food intake disorder without weight and shape-related psychopathology (non-AN group). METHOD: Medical and psychiatric data were obtained from the case records of a consecutive series of 102 children with an eating disorder and a pronounced low weight who were below the age of 13 at the start of treatment. RESULTS: Fifty-eight patients constituted the AN group, and 44 constituted the non-AN group. The non-AN group was younger and had a longer duration of symptoms than the AN group. The non-AN group also had a lower maximum premorbid weight and shorter stature. There were no differences in medical severity, but the AN group had more psychiatric treatment. DISCUSSION: The non-AN group seems to have a medically equally severe disorder as the AN group, but is less often detected and properly treated. Copyright © 2016 The Authors European Eating Disorders Review published by Eating Disorders Association and John Wiley & Sons Ltd. (Less)

Alcohol use disorders are common in developed countries, where alcohol is cheap, readily available, and heavily promoted. Common, mild disorders often remit in young adulthood, but more severe disorders can become chronic and need long-term medical and psychological management. Doctors are uniquely placed to opportunistically assess and manage alcohol use disorders, but in practice diagnosis and treatment are often delayed. Brief behavioural intervention is effective in primary care for hazardous drinkers and individuals with mild disorders. Brief interventions could also encourage early entry to treatment for people with more-severe illness who are underdiagnosed and undertreated. Sustained abstinence is the optimum outcome for severe disorder. The stigma that discourages treatment seeking needs to be reduced, and pragmatic approaches adopted for patients who initially reject abstinence as a goal. To engage people in one or more psychological and pharmacological treatments of equivalent effectiveness is more important than to advocate a specific treatment. A key research priority is to improve the diagnosis and treatment of most affected people who have comorbid mental and other drug use disorders.

Using a quantitative content analysis, this study focused on how depression has been portrayed and communicated on Pinterest. Key findings include: Depression-focused pins elicited high response levels for repins, likes, and comments, and more than half of the pins expressed perception of depression as a severe disorder. Various coping mechanisms were present in the pins, with the dysfunctional coping strategy most prevalent. Implications for practitioners on how to utilize visual media platforms to effectively engage at-risk publics on health issues were discussed.

Schizophrenia is a mental disorder which includes: positive symptoms, negative symptoms, cognitive symptoms, affective symptoms and aggressive symptoms. Cognitive disorder is the most severe disorder compared to other symptoms of schizophrenia because it can interfere with daily functions, including memory function, attention function, problem solving function, speech function and social skills.

Familial hypocalciuric hypercalcemia (FHH) and neonatal severe hyperparathyroidism (NSHPT) are genetically determined variants of primary hyperparathyroidism. FHH usually has a benign course, and patients do not require treatment, whereas NSHPT is a severe disorder often requiring early parathyroidectomy for young patients to survive. Recent discoveries in the genetic basis and new findings in therapeutic approaches have led to a great interest in these rare diseases.

STUDY OBJECTIVES: Autistic traits present a continuum from mild symptoms to severe disorder and have been associated with a high prevalence of sleep problems. Sleep spindles have a key function in sleep maintenance and in brain plasticity. Previous studies have found decreased spindle activity in clinical autism. Here we examine the associations between the entire range of autistic traits and sleep spindle activity in a nonclinical community cohort of adolescents. METHODS: Our cohort is based on 172 adolescents born in 1998 (58.7% girls, mean age = 16.9 years, standard deviation = 0.1), who filled in the adult autism-spectrum quotient (AQ), consisting of total score, and social interaction and attention to details subscales. Participants underwent an ambulatory overnight sleep electroencephalography. Sleep spindles (amplitude, duration, density, and intensity) were automatically detected from stage N2 sleep, and divided to slow and fast spindles. RESULTS: Higher AQ total sum and social interaction sum associated with lower fast spindle amplitude and intensity (P < .04). No associations were observed for attention to details. CONCLUSIONS: Our findings indicate that a higher level of autistic traits in the nonclinical range among generally healthy adolescents associate with similar alterations in sleep spindle activity as observed in many neuropsychiatric conditions, indicating lower sleep-related brain plasticity. This indicates that sleep microstructures form a continuum that follows self-reported symptoms of autism. CITATION: Merikanto I, Kuula L, Makkonen T, Salmela L, Räikkönen K, Pesonen AK. Autistic traits are associated with decreased activity of fast sleep spindles during adolescence. J Clin Sleep Med. 2019;15(3):401–407.

“Developmental breakdown” represents a concern that remains central to our work at the Brent Adolescent Centre. And this concern, which must certainly be shared by anybody who works with the troubled adolescent, can be summarized as follows: how do we know when to be worried, and when is help urgent? Implied in this is that there are adolescents who may be troubled but about whom we need not be especially concerned, whereas there is a group of adolescents whose troubles represent signs of a serious disorder or, at least, of the likelihood of severe mental disturbance in the near-present or in the future. It is this latter group on whom I would like to concentrate, because they are the ones whose emotional lives—and often actual lives—are seriously at risk, and who must not be left with the unreal hope that they will grow out of it. Our experience shows that these adolescents do not “grow out of it” but remain emotionally damaged at the least and actually develop towards mental illness at the worst, if they are left on their own. With help at the right time, we think that some of these adolescents can be helped greatly, often with the possibility of reversing the move towards the firm establishment of severe disorder.

Objective: The tendency over the years in the mental health field has been to cling in circular fashion to one single domain after another, biological, psychological, or social, to explain severe disorder and not even to consider the data from the domain of focus that came before. This report notes that attempts to explore more complex biopsychosocial explanations that integrate the diverse domains have been generally ignored or foundered on the problems posed by the complexities involved and suggests an approach for moving beyond these problems. Method: A case history using two different formats highlights the degree to which the single domain models ignore one or another area of data. Results: Uncertainty theory is suggested as providing an important basis for exploring the complexities of a biopsychosocial understanding of mental health problems. Conclusions: This approach can provide a possible orientation to promote improved research, training, and treatment.

Health and welfare issues concerning brachycephalic dogs have gathered increasing interest from the veterinary world. Several veterinary associations and their journals, such as the BVA and Vet Record ,1 and The Canadian Veterinary Journal 2,3 have published comments and editorials expressing their concerns with the rising number of reported breed-specific health issues and the increasing popularity of brachycephalic breeds leading to inappropriate breeding. These issues have ignited debate about the role of veterinary surgeons in raising these issues with the general public. The BVA is currently actively campaigning on social media (#BreedtoBreathe) and one of their calls to action is for a ban on adverts featuring brachycephalic breeds in order to decrease demand for the breed. Brachycephalic obstructive airway syndrome (BOAS) is probably the most common and severe disorder reported in brachycephalic breeds.4, 5 In 2017, an internal study was performed by a US pet insurance company looking at claims made by owners not directly related to BOAS.6 It revealed skin and ocular conditions were the most common claims. This is consistent with the results of a large UK study that looked at the health records of pugs presented to primary-care veterinary practices.7 Among the several issues …

Background Major Depressive Disorder (MDD) is a severe disorder with a lifetime prevalence of 15%. Recurrent or chronic MDD, which typically requires long-term treatment, occurs in the majority of patients. As previous efforts to predict recurrence/chronicity have met with limited success, novel avenues are required. In this study, we aimed to predict the future disease status of MDD patients from DNA methylation patterns in blood. Methods We assayed 28 million methylation sites in 581 MDD patients from the Netherlands Study of Depression and Anxiety (NESDA). A Machine Learning algorithm condensed all information into a single predictor labeled methylation risk score (MRS). The outcome was MDD disease status six years later. To evaluate the predictive power of our MRS, we obtained an unbiased estimate of the area under the curve (AUC) using k-fold cross validation. Results The AUC of the MRS was 0.724. We compared our MRS with predictions based on a set of five putative MDD biomarkers (e.g., assaying neurotrophic factors or inflammation), genome-wide genetic variant data, and 27 clinical, demographic or lifestyle variables (e.g., MDD symptom severity, childhood trauma, alcohol use). The MRS not only outperformed all these predictors but also seemed to capture their predictive power as the inclusion of any of these sets did not significantly increase the AUC of the MRS. Discussion The current study suggests a novel avenue for predicting future MDD status using DNA methylation patterns in blood. The predictive power of the MRS is comparable to the AUC of the Framingham Risk Score, one of the most widely used clinical tools to predict coronary heart disease. This AUC level can potentially support clinical decisions about treatment strategies by providing empirical information about the likelihood MDD is chronic or will recur in the future.

We examined the prevalence of body dysmorphic disorder (BDD) in a Veterans Affairs (VA) primary care behavioral health clinic. Of 100 Veterans, 11% (95% CI = 6.3-18.6%) had current BDD and 12% (95% CI = 7.0-19.8%) had lifetime BDD. However, only 8.3% of these Veterans had been diagnosed with BDD. BDD was significantly associated with a substantially elevated rate of suicide attempts, major depression, and obsessive-compulsive disorder. This severe disorder appears to be underdiagnosed in VA settings.

Purpose – The purpose of this paper is to explore and review the range and quality of international epidemiological and observational studies reporting impacts of psychiatric disorders on labour force activity. This information is needed to explore the relative priority of different diagnostic groups for more intensive forms of vocational rehabilitation. Design/methodology/approach – The authors provide an overview of the current literature. A systematic review of papers measuring labour force variables and psychiatric disorders across a range of countries is conducted. These results are compared to OECD background unemployment rates during the same period. The results for each diagnostic category included are aggregated and compared to the other diagnostic categories. Findings – The proportions of people employed decreased with the more severe disorder categories, indicating that severe psychiatric illnesses are contributing to employment struggles for people with these illnesses, across countries. Research limitations/implications – This review is exploratory and shows that there is little consistency in reporting of labour force variables. Future research should endeavour to utilise internationally agreed definitions of labour force activity. Practical implications – This conclusion is relevant to matching community residents with psychiatric disorders to the more intensive and costly forms of vocational rehabilitation. Originality/value – To our knowledge, no previous review has examined diagnostic categories of psychiatric disorders by labour force activity internationally while taking into account background unemployment. This review found an employment gradient related to severity of diagnostic category that will be of interest to clinicians and policy makers.

D-Bifunctional protein deficiency, caused by recessive mutations in HSD17B4, is a severe disorder of peroxisomal fatty acid oxidation. Nonspecific clinical features may contribute to diagnostic challenges. We describe a newborn female with infantile-onset seizures and nonspecific mild dysmorphisms who underwent extensive genetic workup that resulted in the detection of a novel homozygous mutation (c.302+1_4delGTGA) in the HSD17B4 gene, consistent with a diagnosis of D-bifunctional protein deficiency. By comparing the standard clinical workup to diagnostic analysis performed through research-based whole-genome sequencing (WGS), which independently identified the causative mutation, we demonstrated the ability of genomic sequencing to serve as a timely and cost-effective diagnostic tool for the molecular diagnosis of apparent and occult newborn diseases. As genomic sequencing becomes more available and affordable, we anticipate that WGS and related omics technologies will eventually replace the traditional tiered approach to newborn diagnostic workup.

Although estuaries are proposed as habitats for many maritime fishes’ types, the expansion of human actions and his activities in order to maintain himself quickly has been resulted in losing the life of a variety species of marine organisms and degradation of their living environments inside the estuaries and surrounding areas. With the dominant part of Earth's people living in the seaside ranges, estuarine biological ecosystems have been especially influenced by exacerbated of human activities. One of the objectives of this review was to see how these unsettling influences impress estuarine life forms, especially fishes, shellfish, and oysters. As a basic species of critters available in this world, oysters or other weeny marine organisms give livelihood meal, shelter, nursery natural habitat and numerous imperative things for a vast assortment of other creatures estuarine. Another biologically detrimental severe disorder influencing estuaries is an anthropogenic adjustment of freshwater flow and creating changes in the quality of water designs in terms of saltiness. Since estuaries are territories which connect land to the sea and are situated between freshwater and saltwater, any increase in saltiness mutations through human activities have likewise prompted a serious debasement of oyster reef living environments in rivers.Thus this inquiry is not only containing remonstrative reasons for the protection and attention to the management of littoral rivers by the government, but also it is, for the most part, perceived that general human impedance and usage of stream catchments can considerably affect contrarily on the wellbeing situation, the quality of water, and stylish estimation of estuaries. Hence, the analyst's aim is to attempt a more comprehensive approach with a specific end goal to investigate the degree to which both physical and human effects influence these life supporting frameworks.

Megacystis microcolon intestinal hypoperistalsis syndrome (MMIHS) is a rare and severe disorder of functional obstruction affecting bladder and bowel, usually diagnosed in the neonatal period. Over 230 cases have been reported since Berdon and colleagues first described this clinical entity in 1976. The exact pathogenesis of MMIHS is unknown. Familial occurrence of MMIHS has been reported and could offer insight into the aetiology of this disease. The purpose of this study was to systematically review the published literature for the evidence of familial MMIHS and to characterise these presentations.A literature search was performed using the keywords "megacystis microcolon intestinal hypoperistalsis" (1976-2013). Retrieved articles, including additional studies from reference lists, were reviewed for consanguinity between parents and recurrence of MMIHS between siblings. Data were extracted for cases where familial MMIHS was present.A total of 47 patients were reported in which familial MMIHS was likely or confirmed. 15 sibling sets were definitively diagnosed with MMIHS (14 pairs and one set of three siblings). Four further index patients with a confirmed diagnosis and also one of the sibling pairs were reported to have a sibling in which MMIHS was probable. Consanguinity between parents was present in four of the confirmed sibling sets and in an additional seven individual cases. The outcome for familial MMIHS is generally poor. Multiple sibling fatalities were frequent and in only one family were both siblings' survivors at the time of reporting.Consanguinity between parents and recurrence in siblings indicate that MMIHS is inherited in an autosomal recessive manner. With the advent of next generation sequencing, these familial clusters may be key to determining the genetic basis for MMIHS.

Osteomyelitis is a challenging diagnosis for every patient because of its protracted treatment process. Very experienced orthopaedic surgeons are needed to diagnose and treat this bacteria-related severe disorder in a right and proper way.Different treatment options are possible for osteomyelitis at any stage: antibiotics in the acute and chronic stage for conservative treatment or radical debridement, bone fenestration, reaming, bone troughing, the Masquelet-technique, segmental resection with callus distraction, bone grafting and even amputation as surgical therapy.Depending on different stages of the disease, there are good results with every technique available-on condition that radical debridement was performed. The complication rate is remarkable so that soft tissue defects should be assessed by using flaps to close the wounds in early stages.The treatment of osteomyelitis should be done in centres with expertise in the treatment of this challenging disease. Different methods should be offered by surgeons and individual treatment concepts acquired together with the patient. The treatment of complications like soft tissue defects should be provided in the same centre and performed in short time lag to the prior surgery. The cooperation of the patient and surgeons of different specialities is mandatory in these cases.

Confusion and delirium are the most common behavioural disorders seen in an acute medical or surgical unit. Confusion can be regarded as a mild form of delirium and may give warning of the development of the more severe disorder. It causes an acute change of mental status, characterized by abnormal and fluctuating attention. It affects between 10 and 30% of medically ill patients, especially the elderly and often shortly after admission to hospital. It causes prolonged admission, increased morbidity and mortality, and delayed discharge, often culminating in long-term care. Its causation is reviewed and its prevention and management are described.

BackgroundThis report prospectively examines the 4-year course, and predictors of course, of body dysmorphic disorder (BDD), a common and often severe disorder. No prior studies have prospectively examined the course of BDD in individuals ascertained for BDD.MethodThe Longitudinal Interval Follow-Up Evaluation (LIFE) assessed weekly BDD symptoms and treatment received over 4 years for 166 broadly ascertained adults and adolescents with current BDD at intake. Kaplan–Meier life tables were constructed for time to remission and relapse. Full remission was defined as minimal or no BDD symptoms, and partial remission as less than full DSM-IV criteria, for at least 8 consecutive weeks. Full relapse and partial relapse were defined as meeting full BDD criteria for at least 2 consecutive weeks after attaining full or partial remission respectively. Cox proportional hazards regression examined predictors of remission and relapse.ResultsOver 4 years, the cumulative probability was 0.20 for full remission and 0.55 for full or partial remission from BDD. A lower likelihood of full or partial remission was predicted by more severe BDD symptoms at intake, longer lifetime duration of BDD, and being an adult. Among partially or fully remitted subjects, the cumulative probability was 0.42 for subsequent full relapse and 0.63 for subsequent full or partial relapse. More severe BDD at intake and earlier age at BDD onset predicted full or partial relapse. Eighty-eight percent of subjects received mental health treatment during the follow-up period.ConclusionsIn this observational study, BDD tended to be chronic. Several intake variables predicted greater chronicity of BDD.

Maladaptive cognitive processes, including selective attention and memory, distorted beliefs and interpretations, and thinking processes such as rumination and thought suppression, are strongly associated with many emotional disorders. This paper reviews research that extends these findings to the emotional dysfunction characteristic of borderline personality disorder (BPD). Results suggest that people with BPD habitually attend to negative stimuli, have disproportionate access to negative memories, endorse a range of BPD-consistent negative beliefs about themselves, the world, and other people, and make negatively biased interpretations and evaluations of neutral or ambiguous stimuli. They also engage in thought suppression and rumination and these tendencies are significantly associated with the severity of their BPD symptoms. It remains unclear whether maladaptive cognitive processes play a causal role in the development and maintenance of BPD or are correlates or consequences of having the disorder. Continued study of emotion-related cognitive processing in BPD may improve understanding and treatment of this severe disorder.

Murru A, Pacchiarotti I, Nivoli AMA, Bonnin CM, Patrizi B, Amann B, Vieta E, Colom F. Rates and clinical correlates of treatment non-adherence in schizoaffective bipolar patients. Objective: To analyze demographical, clinical, and therapeutic variables that may be associated with pharmacological non-adherence in a sample of schizoaffective patients, bipolar type. Method: Adherence to treatment and its clinical correlates were assessed at the end of a 10-year follow-up in 76 patients meeting DSM-IV-TR diagnosis of schizoaffective disorder, bipolar type. Adherent and poorly adherent patients were compared regarding clinical and therapeutic variables. Results: The rate of poorly adherent patients was 32/76 (41.2%) of the sample. Adherent patients were more likely to have presented an affective episode at illness onset and to have fewer purely – non-affective – psychotic episodes. Demographic or other clinical variables were not found to be associated to treatment adherence. Family history for psychiatric disorders or suicide did not correlate either, and neither did any specific pharmacological agent. Conclusion: Rates of non-adherence in schizoaffective disorder are high. Adherence seems to be associated to a more affective course of illness (affective first episode and fewer purely psychotic episodes). Patients with more prominent schizophrenia-like characteristics could be at higher risk for poor adherence and need to be closely followed and monitored. Even when properly treated, schizoaffective disorder is a disabling and severe disorder with high risk for recurrences.

The operational model and strategies designed for use in the S. Anna - Research in Advanced Neurorehabilitation Institute for the care and neurorehabilitation of subjects in the vegetative or minimally conscious states are described here. A total of 722 patients were admitted, cared for and discharged from the institute in the period 1998-2009. Application of the model approach has progressively shortened the time of hospitalization and rehabilitation and reduced costs.

Objective To review the applicability of heart rate variability measures in research on severe disorder of consciousness. Methods The available evidence on the correlation between heart rate variability measures and the outcome or residual functional state/responsiveness of severely brain-injured patients (including those in vegetative or minimally conscious states) are reviewed and discussed with reference to the central autonomic network model. Results and conclusion Heart rate variability analyses appear to be applicable to assess residual or emerging (higher level) function in brain-injured patients with disordered consciousness and to predict outcome. In this regard, the central autonomic network model is heuristic in the understanding of heart rate variability descriptors of the central nervous system/autonomic systems relationship.

Schizophrenia is a severe disorder affecting approximately 1% of the population. In 2004, the health care and productivity lost cost of schizophrenia in Canada was estimated at $7 billion (Goeree et al., 2005). Deficits in interacting with the social world are some of the most debilitating aspects of the disorder. Specifically, problems in recognising emotions on faces contribute to difficulties with many kinds of interpersonal interactions and worsen day-to-day functioning in schizophrenia. Currently, however, there is a lack of information on the biological and genetic underpinnings of these impairments. The author presents a series of studies investigating facial emotion recognition in individuals with schizophrenia and their family members, and individuals with bipolar disorder. Studying healthy family members eliminates the problems of controlling for medication exposure and other illness factors that are often present in studies of schizophrenia. This design makes it likely that deficits that are identified in both affected and unaffected relatives are markers of biological changes that are risk factors for schizophrenia. Isolating the biological and genetic basis of problematic social interactions in people with schizophrenia will ultimately aid in developing new treatments to facilitate improved day-to-day functioning.Keywords: schizophrenia, emotion recognition, MRI, social cognition, family studiesResumeLa schizophrenie est une condition grave qui touche pres de 1 % de la population. En 2004, les soins de sante et les couts en perte de productivite attribuables a la schizophrenie au Canada ont ete estimes a 7 milliards de dollars (Goeree et al., 2005). Les lacunes en matiere d'interaction sociale sont parmi les aspects les plus debilitants du trouble. Plus precisement, la difficulte de reconnaitre les emotions sur les visages contribue aux malaises dans plusieurs types d'interactions interpersonnelles et nuit aux activites quotidiennes. Actuellement, il y a peu d'information sur les elements biologiques et genetiques sous-jacents a ces manques. L'auteur presente une serie d'etudes portant sur la reconnaissance des expressions emotionnelles du visage chez les individus souffrant de schizophrenie et les membres de leur famille, et chez les personnes atteintes du trouble bipolaire. L'etude des membres en sante de la famille elimine la necessite de verifier l'exposition a de la medication et d'autres facteurs medicaux qui sont souvent presents dans les etudes sur la schizophrenie. Cette facon de proceder suggere que les deficits qui sont cernes a la fois chez les membres schizophrenes et ceux qui ne le sont pas sont des marqueurs de changements biologiques constituant des facteurs de risque en ce qui a trait a la schizophrenie. La determination des bases biologiques et genetiques des interactions sociales problematiques chez les individus schizophrenes contribuera eventuellement a l'etablissement de nouveaux traitements qui faciliteront les activites quotidiennes.Mots-cles : schizophrenie, reconnaissance d'emotions, IRM, cog- nition sociale, etudes de la famille.My research focuses on elucidating the biological bases of dysfunction in schizophrenia. My laboratory brings together mul- tiple methodologies, including structural and functional MRI, be- havioural genetics (i.e., family studies), cognitive and affective experimental psychology, and clinical assessment. We are working on a variety of projects aimed at developing novel cognitive and affective experimental tasks that tap different neural circuits in healthy and psychiatric populations, and understanding brain ab- normalities and behaviour in schizophrenia. The ultimate goal of my laboratory is to use information on basic brain mechanisms to develop neurobiologically targeted treatments.One of the main trajectories of my laboratory is to advance scientific knowledge in the domain of emotion recognition in schizophrenia. …