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The annual incidence of glaucoma progression (9.7%) and rates of visual field mean deviation (MD) change in progressors (-1.02±0.06 dB/y) are high in a small cohort of urban Ghanaians.To report the incidence of glaucoma progression and the rate of visual field deterioration in a small cohort of Ghanaians.One hundred ten subjects (204 eyes) diagnosed with glaucoma at a baseline population-based screening examination were re-examined a mean of 8.3±0.8 years later. Eyes were classified as having progressed if the optic disc alone, visual field alone or both showed significant glaucomatous changes on follow-up. Visual field MD was used to calculate the rate of visual field progression.Progression was observed in 89 (80.9%, 9.7%/year) subjects (130 eyes). Progression occurred in 32 (31.7%, 3.8%/year) subjects by optic disc alone (46 eyes), 38 (44.7%, 5.4%/year) subjects by visual field alone (58 eyes), and 19 (25.0%, 3.0%/year) subjects by both modalities (26 eyes). The average rate of change in MD differed significantly between progressors (-1.02±1.06 dB/y) and nonprogressors (+0.089±0.49 dB/y), P =0.001. The rate of visual field worsening was greater among those who were classified as having progressed by both structure and function (-1.29±0.68 dB/y) and by function alone (-1.21±1.20 dB/y) than by structure alone (-0.55±0.76 dB/y). Progression was significantly associated with older age [odds ratio (OR), 1.42; P0.001] and higher baseline intraocular pressure (OR, 1.18; P =0.002). Factors associated with rate of MD change were baseline older age (OR, 1.66; P =0.003), higher intraocular pressure (OR, 2.81; P =0.007), better visual field MD (OR, 1.41; P =0.004), and systemic hypertension (OR, 1.15; P =0.029).The incidence and rate of visual field progression are high in this longitudinal study of Ghanaian subjects with glaucoma. The findings may have important clinical and public health policy ramifications.

To determine the incidence of open-angle glaucoma (OAG) and its risk factors in the Tema Eye Survey in Ghana, West Africa.Longitudinal, observational population-based study.One thousand two hundred five of 1500 participants 40 years of age or older selected randomly from 5603 participants originally drawn from the population and who had undergone a baseline examination.All participants underwent baseline and follow-up ophthalmologic examinations 8 years apart. Glaucoma diagnosis was determined based on the International Society for Geographical and Epidemiologic Ophthalmology criteria.Incidence and odds ratio (OR).The response rate was 80.3%. Of 1101 nonglaucomatous participants at baseline who had complete follow-up data, 4.6% (95% confidence interval [CI], 3.7%-5.2%) demonstrated OAG over the 8-year period, or 0.58% (95% CI, 0.4%-0.8%) per year. The 8-year incidence increased with age from 3.1% in those 40 to 49 years old to 7.0% in those 60 to 69 years old. Baseline risk factors for incident OAG were male gender (OR, 2.1; 95% CI, 1.1-4.0; P = 0.025), older age relative to those 40 to 49 years old (those 50-50 years old: OR, 2.6; 95% CI, 1.2-5.7; those 60-69 years old: OR, 4.3; 95% CI, 2.0-8.8; and for those 70 years of age and older: OR, 6.3; 95% CI, 2.6-15.4; all P0.001), higher intraocular pressure (IOP; OR, 1.4; 95% CI, 1.1-1.8; P 0.001), larger vertical cup-to-disc ratio (OR, 5.8; 95% CI, 5.2-6.6; P0.001), and thinner central cornea (OR, 1.2; 95% CI, 1.03-1.5; P = 0.013). A separate analysis performed with central corneal thickness-based IOP correction did not change the outcome of the associative model of incident glaucoma.The incidence of OAG is higher in this population than reported in nonblack populations outside Africa. This is important not only in Ghana and probably other West African countries but also wherever people of the West African diaspora reside. These data enhance our understanding of the epidemiologic factors of OAG in this setting and may serve as reference for public health policy and planning.

To determine the change and rate of change in central corneal thickness (CCT) and their determinants.Longitudinal observational population-based study.A total of 758 normal and 58 glaucomatous subjects underwent complete eye examination, with CCT measurements at 2 separate visits. Change and rate of change in CCT were determined. Univariate and multivariate linear regression analyses were performed to determine the factors associated with change and rate of change.The mean follow-up duration was 8.4 ± 0.7 years. The overall change was -8.9 ± 16.7 μm in OD and -9.8 ± 16.2 μm in OS, both P.0001. Changes in glaucomatous and normal subjects were -14.1 ± 2.2 μm vs -8.6 ± 0.6 μm in OD (P = .02) and -14.5 ± 2.2 μm vs -9.5 ± 0.6 μm in OS (P = .03), respectively. The overall rate of thinning was -1.1 μm/year (OD) and -1.2 μm/year (OS). Rates in glaucomatous and normal eyes were -1.7 ± 0.3 μm/year vs -1.0 ± 0.1 μm/year in OD (P = .02) and -1.7 ± 0.3 μm/year vs -1.1 ± 0.1 μm/year in OS (P = .03), respectively. Change and rate of change were associated with baseline CCT (ß = -0.1 to -0.09 and -0.011, respectively, all P.001) and glaucoma (ß = -6.8 to -5.6, P ≤ .009, and -0.75 to -0.69, P ≤ .007, respectively).CCT decreased significantly over time. The change and rate of change were greater in glaucomatous than normal eyes, and were greater than described in cross-sectional studies.

Specific learning difficulties (SLDs), of which dyslexia is the most widely recognized, may not be identified early and specialist resources for remediation are not always available in mainstream education in the UK. The prevalence, causes and cognitive mechanisms of different types of SLD are described in this article, together with their inter-relationships and association with other developmental disorders such as language disorders, autism and attention deficit hyperactivity disorder (ADHD). Especially when unrecognized, SLDs can contribute to the development of emotional and behavioural difficulties and can complicate the management of ADHD. SLDs are common, especially in boys referred to child and adolescent mental health services, and professionals must be alert to the possible contribution of an SLD to emotional and/or behavioural problems and understand the impact on the individual child’s functioning, especially at school. The assessment and management of SLDs are discussed, together with respective roles of health and education professionals to facilitate liaison. Health professionals can, when necessary, support families in making the case for a psychometric assessment, a full assessment of special educational needs and for additional resources in school. Phonological impairment causes persistent literacy, mathematical and subtle language difficulties that, even in highly intelligent children, affect educational progress and contribute to emotional difficulties. Disadvantaged children and those who also have ADHD, dyspraxia or a history of language disorder are particularly at risk of antisocial behaviour and school exclusion. For complex or comorbid SLD, treatment of ADHD with methylphenidate and therapeutic work with the child and his family are vital as early as possible to prevent the development of academic failure, low self-esteem or serious behaviour problems.

Psychiatric epidemiologic surveys since 1980 have relied heavily on a small number of survey diagnostic instruments for case ascertainment, which encode reports of respondents to highly structured interview questions delivered by interviewers without clinical training. Many validations of these survey diagnostic instruments have been carried out.This paper reviews the success of the survey diagnostic instruments, for eight diagnostic categories, in validations with a psychiatrist examination as the gold standard.Public databases were searched for potentially relevant publications, of which more than 1000 were located. Tables show sensitivity, specificity, Kappa, sample source and size, survey instrument and validation method.The number of validation studies relevant to the eight disorders ranged from 8 for schizophrenia to 29 for major depressive disorder. Reported sensitivities ranged from zero to 100%, and specificities from 22% to 100%.Results for common mental disorders such as major depressive disorder, alcohol disorder, drug disorder, and agoraphobic disorder are better than for panic disorder, obsessive compulsive disorder, bipolar disorder, and schizophrenia. The validity of case ascertainment in psychiatric epidemiology is still in question.

The Social Competence Interview (SCI), an interview to induce cardiovascular reactivity through recounting a stressful life experience, was used with a sample of 120 working women employed as childcare providers. Women recounted their most stressful work factor while cardiovascular reactions were monitored at 2-minute intervals (data points included 4 baseline, 6 SCI, and 3 recovery). Increases were found when comparing mean baseline and SCI measures: systolic blood pressure (SBP) increased 10.00 mmHg; diastolic blood pressure (DBP)increased 10.63 mmHg; and heart rate increased 4.57 beats per minute. Consistent with the literature SBP and DBP were higher for some subgroups of women (those who were 50 years or older, were obese, or had 4 or more risk factors) across all data points. There were no time by individual difference interactions, indicating that the patterns of change over time were the same across groups. In a logistic regression, comparing women who reached SBPor = 140 mmHg and/or DBPor = 90 mmHg during the SCI versus those who did not, higher BP was associated with being older and obese, having a higher level of acceptance coping, and a lower level of suppression of competing activities coping.

This chapter explains how mental illness affects parenting and influences the development of children. It talks about abuse and neglect, the effects of separation and the risk of mental health problems in children. Large numbers of children grow up with a mentally ill parent. A study of parental psychiatric histories of 850 twin pairs in Virginia found that only 26% of families had no lifetime history of psychiatric disorder in either parent. The chapter outlines a developmental framework to help understand the interrelationship of risk variables in the development of the child, the emergence of disturbance and its modification. Clinically, this framework may assist with the developmental assessment of children. The effects of social disadvantage are discussed. The catalogue of risks for children of mentally ill parents described in the chapter emphasizes the need for skilful coordination of professionals involved with both the parents and the children.

Background: Testing for monogenic cardiac disorders in minors is an increasingly common consideration. The asymptomatic at-risk minor raises additional medical and ethical concerns. These include predicting age of onset, implications on lifestyle, competitive sport and career planning, medication advice and family history of sudden death. We report on the outcomes of minors referred to a cardiac genetics service over a 5 year period.We specifically focus on minors subsequently referred to psychiatry for an assessment of competency. Results: A total of 78 minors were seen which represented 15.9% of all new referrals (78/492). 48 minors (61.5%) presented for carrier testing, with 29 offered testing (60%). A family history of sudden death in a parent or sibling was another frequent reason for referral (16.7%; 13/78). Of the 48 children who presented for carrier testing 11 (14%) were referred to psychiatry for an assessment of competency. Predictive testing was not performed because it was declined by the family, deferreduntil theminorwasolder, or not available. Conclusions: There are medical reasons to offer testing in childhood and parental consent is obtained in those circumstances. Testing is delayedwhere possible to allow for patient autonomy. If there are no clear medical reasons to offer testing and the minor is requesting testing, an assessment of competency is made. Complex psychosocial issues are common and an assessment of competency can be challenging. Significant parental anxiety often surrounds identification of the minor’s genotype. A psychiatry referral for additional assessment of competency and support options is appropriate in some cases.

As child mental health clinics round the country develop longer and longer waiting lists it is tempting to suggest ways of helping children in other settings so that overextended specialist staff can concentrate on specific complex disorders. If additional resources were made available to local authorities so that children with conduct disorder could receive input to improve their behaviour early in childhood, professionals, parents of affected children, and society as a whole would be delighted. Specialist education staff could help teachers in managing children more effectively using behavioural programmes in mainstream classes or in small groups. Social workers might be able to provide family therapy and behaviour therapy to help parents manage behaviour effectively rather than concentrating on child protection work, accommodating children, or programmes for delinquents. This preventive rather than palliative approach is advocated by the Department of Health.1 …

Circulating levels of adiponectin, a hormone produced predominantly by adipocytes, are highly heritable and are inversely associated with type 2 diabetes mellitus (T2D) and other metabolic traits. We conducted a meta-analysis of genome-wide association studies in 39,883 individuals of European ancestry to identify genes associated with metabolic disease. We identified 8 novel loci associated with adiponectin levels and confirmed 2 previously reported loci (P = 4.5×10−8–1.2×10−43). Using a novel method to combine data across ethnicities (N = 4,232 African Americans, N = 1,776 Asians, and N = 29,347 Europeans), we identified two additional novel loci. Expression analyses of 436 human adipocyte samples revealed that mRNA levels of 18 genes at candidate regions were associated with adiponectin concentrations after accounting for multiple testing (p, Author Summary Serum adiponectin levels are highly heritable and are inversely correlated with the risk of type 2 diabetes (T2D), coronary artery disease, stroke, and several metabolic traits. To identify common genetic variants associated with adiponectin levels and risk of T2D and metabolic traits, we conducted a meta-analysis of genome-wide association studies of 45,891 multi-ethnic individuals. In addition to confirming that variants at the ADIPOQ and CDH13 loci influence adiponectin levels, our analyses revealed that 10 new loci also affecting circulating adiponectin levels. We demonstrated that expression levels of several genes in these candidate regions are associated with serum adiponectin levels. Using a powerful novel method to assess the contribution of the identified variants with other traits using summary-level results from large-scale GWAS consortia, we provide evidence that the risk alleles for adiponectin are associated with deleterious changes in T2D risk and metabolic syndrome traits (triglycerides, HDL, post-prandial glucose, insulin, and waist-to-hip ratio), demonstrating that the identified loci, taken together, impact upon metabolic disease.

Our project investigating the mental health of medical students1 developed from a team member’s post as a student welfare officer for a London medical school in 2003. With the support of the medical school, we designed a cross sectional …

Richardson AJ, Montgomery Paul. The Oxford-Durham study: a randomized, controlled trial of dietary supplementation with fatty acids in children with developmental coordination disorder. Pediatrics 2005;115:1360–6. [OpenUrl][1][Abstract/FREE Full Text][2] Q In children with developmental coordination disorder (DCD), do fatty acid supplements improve motor function, reading and spelling levels, and symptoms of attention deficit/hyperactivity disorder (ADHD)? Clinical impact ratings Paediatrics ★★★★★★☆ Psychiatry ★★★★★★☆ ### ![Graphic][3] Design: randomised placebo controlled trial (Oxford-Durham Study). ### ![Graphic][4] Allocation: concealed.* ### ![Graphic][5] Blinding: blinded (patients, clinicians, and outcome assessors).* ### ![Graphic][6] Follow up period: 3 months. ### ![Graphic][7] Setting: 12 elementary schools in County Durham, UK. ### ![Graphic][8] Patients: 117 patients (mean age 8.8 y, 67% boys) who met DSM-IV criteria for DCD and were not receiving any treatment. Exclusion criteria: any major physical or mental health condition (eg, epilepsy, diabetes mellitus, depression, or chronic fatigue syndrome). ### ![Graphic][9] Intervention: fatty acid supplements (2 capsules 3 times per d) (n = 60) or matching placebo (n = 57). The supplements consisted of 80% fish oil (sardine and pilchard) and 20% evening primrose … [1]: {openurl}?query=rft.jtitle%253DPediatrics%26rft.stitle%253DPediatrics%26rft.issn%253D0031-4005%26rft.aulast%253DRichardson%26rft.auinit1%253DA.%2BJ.%26rft.volume%253D115%26rft.issue%253D5%26rft.spage%253D1360%26rft.epage%253D1366%26rft.atitle%253DThe%2BOxford-Durham%2BStudy%253A%2BA%2BRandomized%252C%2BControlled%2BTrial%2Bof%2BDietary%2BSupplementation%2BWith%2BFatty%2BAcids%2Bin%2BChildren%2BWith%2BDevelopmental%2BCoordination%2BDisorder%26rft_id%253Dinfo%253Adoi%252F10.1542%252Fpeds.2004-2164%26rft_id%253Dinfo%253Apmid%252F15867048%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=pediatrics&resid=115/5/1360&atom=%2Febmed%2F10%2F6%2F181.atom [3]: /embed/inline-graphic-1.gif [4]: /embed/inline-graphic-2.gif [5]: /embed/inline-graphic-3.gif [6]: /embed/inline-graphic-4.gif [7]: /embed/inline-graphic-5.gif [8]: /embed/inline-graphic-6.gif [9]: /embed/inline-graphic-7.gif

Ed Rosemary Chesson, Douglas Chisholm Jessica Kingsley, pounds sterling16.95, pp 278 ISBN 1 85302 329 9 Inpatient psychiatric units for children are under threat. Despite a 50% increase in psychiatric admissions of 10-14 year olds recorded by the Department of Health recently, the number of beds in the United Kingdom is falling and many units are offering only five day or day patient care. Although the absolute numbers of highly disturbed children remains relatively small, such children have a grossly disproportionate impact on outpatient mental health services and social services. Vast amounts of precious professional time can …

Thirty out-patients with severe anorexia nervosa were randomly allocated to either 12 sessions of dietary advice or 12 sessions of combined individual and family psychotherapy. At one-year follow-up both groups showed significant overall improvement, and the dietary advice group showed significant weight gain. A similar mean weight gain for the psychotherapy patients did not reach statistical significance, but this group made significant improvements in sexual and social adjustment.

This paper reports observations following on a study of anorexia nervosa in 34 twins and one set of triplets, and within which approximately half the monozygotic (MZ) twins displayed concordance, compared with 7% of the dizygotic (DZ) twins. One additional case, involving childhood adoptions, is described, wherein neither genetic nor specifically assortative selection factors seem to have been at work. The findings suggest that genetic and environmental factors can interact to contribute to the development of this apparently culture-based and multifactorially derived condition. A number of possible genetic strands to the condition are proposed; probably not all of them are specifically necessary for its development. The same may apply to experiential influences. Elsewhere it has been argued that the one essential charactistic of anorexia nervosa is avoidance behavior and the factors permitting and facilitating it (Crisp, 1980). Experiential influences, in the form of psychological maturational challenges in adolescence impinging on constitutional propensities to the point of precipitating the disorder out, would seem often themselves to have been influenced by constitutional psychological characteristics and earlier childhood experiences. A further pooling and study of all known twin and adoptive cases might now advance our knowledge of this condition further.

The literature concerning medical marriages is reviewed and, where relevant to potential stress in marriage, the differences between British and North American medical careers are discussed. After a general review of psychiatric morbidity, suicide rates and substance abuse amongst doctors, the major difficulties for married doctors during training are contrasted with the increased stability of mature medical marriages, which nevertheless are relatively unsatisfying for both partners. Little is known about recent medical marriages, particularly in Britain. The likely difficulties for the woman doctor with a non-medical spouse and for dual doctor marriages are discussed, together with the implications for childcare. Problems in marriage are not necessarily associated with the actual number of hours spent working, but satisfaction seems to be associated with communuication and intimacy between the partners.

The need for prospective treatment studies has been emphasized repeatedly in attempts to evaluate long-term outcome in anorexia nervosa (Hsu, 1980). Vigersky (1977), concluding the proceedings of the 1976 International Conference of Anorexia Nervosa Research, stated that only random allocation of patients to different treatment modalities within one center is a valid test of any treatment’s efficacy because of the problems of pre-selection of subjects at different centers.

The third Trainees' Day of the Southern Division took place on 31 March 1982 and was held for the first time in the S.E. Region, at King's College Hospital. We chose topics which are often neglected in peripheral hospitals, but were disappointed to find that trainees from these hospitals were under-represented.

Faced with recruitment difficulties, financial stringency, changing public needs and important advances in clinical and academic psychiatry, the time is ripe for a re-evaluation of the education and training of psychiatrists and factors influencing recruitment to psychiatry. The Conference, held in Cambridge in March, providing a forum for the discussion of such issues involving the Royal College of Psychiatrists, the AUTP and APIT, was an imaginative concept which deserved widespread support within the specialty. However, the breadth of the conception meant that for some organizers and participants it was a conference on training, and for others it was mainly concerned with recruitment.