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Objective: To determine, using a systematic review of case-control studies, whether head injury is a significant risk factor for Alzheimer's disease. We sought to replicate the findings of the meta-analysis of Mortimer et al (1991). Methods: A predefined inclusion criterion specified case-control studies eligible for inclusion. A comprehensive and systematic search of various electronic databases, up to August 2001, was undertaken. Two independent reviewers screened studies for eligibility. Fifteen case-control studies were identified that met the inclusion criteria, of which seven postdated the study of Mortimer et al. Results: We partially replicated the results of Mortimer et al. The meta-analysis of the seven studies conducted since 1991 did not reach significance. However, analysis of all 15 case-control studies was significant (OR 1.58, 95% CI 1.21 to 2.06), indicating an excess history of head injury in those with Alzheimer's disease. The finding of Mortimer et al that head injury is a risk factor for Alzheimer's disease only in males was replicated. The excess risk of head injury in those with Alzheimer's disease is only found in males (males: OR 2.29, 95% CI 1.47 to 2.06; females: OR 0.91, 95% CI 0.56 to 1.47). Conclusions: This study provides support for an association between a history of previous head injury and the risk of developing Alzheimer's disease. [ABSTRACT FROM AUTHOR]

The article explores the long-term changes in patients who had previously suffered from head injury. In some cases, any impairment and disability after two to three years of recovery is fairly fixed. Clinicians are likely to expect any subsequent deterioration such as hydrocephalus. Related studies found out that such changes could sometimes be for better and others are for worse.

The article discusses the study by L. Turner-Stokes and colleagues published in the May 2006 issue of the "Journal of Neurology, Neurosurgery and Psychiatry," which discusses the cost efficiency of neurorehabilitation. Assessment of the patient's dependency was used to estimate the daily cost of care. Dependency of admission were compared to those at discharge and the reduction in daily continuing care cost were calculated

QUESTION: What is the effectiveness of disulfiram for cocaine dependence in patients who are also opioid addicts treated with methadone?DesignRandomised (allocation concealed}*,**, blinded (investigator and patient)-, placebo controlled trial with 12 weeks of follow up.SettingUrban substance abuse treatment centre in the US.Patients69 outpatients (mean age 35 y, 53% women, 74% white}* with DSM-III-R criteria for cocaine dependence who were on methadone treatment and using cocaine frequently (defined as having >/=3 urine toxicology screens positive for cocaine in the 1 mo before study). Exclusion criteria were psychotic or bipolar disorders, serious psychiatric symptoms, or contraindications to disulfiram use. Follow up was 75%. 97% were included in the analysis.InterventionPatients were allocated to disulfiram, 250 mg/day (dissolved directly in the methadone) in=37)*, or placebo in=32)* for 12 weeks. Patients used a mean methadone dose of 88.6 mg/day, and were counselled about the risk of a disulfiram alcohol interaction and advised not to drink alcohol. During the study, patients adhered to a behavioural contract with a reductiori of methadone dose for violations.Main outcome measuresFrequency and quantity of cocaine, alcohol, and other substance use were self reported and verified by urine tests and breathalyser readings.Main resultsPatients who received disulfiram had a lower mean number of days of cocaine use than those who received placebo (5.0 v 6.7 d, p = 0.04). Furthermore, those who received disulfiram had a greater mean decrease in quantity (p=0.02) of cocaine use than those who received placebo; groups did not differ for alcohol or heroin use. The effectiveness of disulfiram did not differ in patients who did and did not use alcohol at baseline.ConclusionDisulfiram was effective in patients with cocaine abuse who were also methadone treated opioid addicts with or without comorbid alcohol abuse.*Information provided by author. **See glossary. [ABSTRACT FROM AUTHOR]

Background: Persistent postconcussional symptoms (PCS) can be a source of distress and disability following traumatic brain injury (TBI). Such symptoms have been viewed as difficult to treat but may be amenable to psychological approaches such as cognitive-behavioural therapy (CBT)., Objectives: To evaluate the effectiveness of a 12-session individualised, formulation-based CBT programme., Method: Two-centre randomised waiting list controlled trial with 46 adults with persistent PCS after predominantly mild-to-moderate TBI (52% with post-traumatic amnesia (PTA)≤24 hours), but including some with severe TBIs (20% with PTA>7 days)., Results: Improvements associated with CBT were found on the primary outcome measures relating to quality of life (using the Quality of Life Assessment Schedule and the Brain Injury Community Rehabilitation Outcome Scale). Treatment effects after covarying for treatment duration were also found for PCS and several secondary outcomes, including measures of anxiety and fatigue (but not depression or post-traumatic stress disorder (PTSD)). Improvements were more apparent for those completing CBT sessions over a shorter period of time, but were unrelated to medicolegal status, injury severity or length of time since injury., Conclusions: This study suggests that CBT can improve quality of life for adults with persistent PCS and potentially reduce symptoms for some, in the context of outpatient brain injury rehabilitation services., Trial Registration Number: ISRCTN49540320., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Background: Gold standard protocols have yet to be established for the treatment of motor conversion disorder (MCD). There is limited evidence to support inpatient, multidisciplinary intervention in chronic, severe cases., Aims: To evaluate the characteristics and outcomes of MCD patients admitted to a specialist neuropsychiatric inpatient unit., Methods: All patients admitted to the Lishman Unit (years 2007-2011) with a diagnosis of MCD were included. Data relevant to characteristics and status with regard to mobility, activities of daily living (ADLs) and Modified Rankin Scale (MRS) score at admission and discharge were extracted., Results: Thirty-three cases (78.8% female) were included; the median duration of illness was 48 months. In comparison with brain injury patients admitted to the same unit, more cases had histories of childhood sexual abuse (36.4%, n=12), premorbid non-dissociative mental illness (81.1%, n=27) and employment as a healthcare/social-care worker (45.5%, n=15). Cases showed significant improvements in MRS scores (p<0.001), mobility (p<0.001) and ADL (p=0.002) following inpatient treatment., Conclusions: Patients with severe, long-standing MCD can achieve significant improvements in functioning after admission to a neuropsychiatry unit., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)