Stettegrupper for skizofrene patienters forældre

Contact between psychiatrists and the patient's family have become of current importance after Julian P. Leff and others of his contemporaries have proved that psychosocial interventions in the environment of the patient can have a positive influence on the course of schizophrenia. This article recounts what we have learned from inviting the relatives of schizophrenic patients to attend group meetings, the purposes of which were 1) to create better contact with the ward and 2) to get relatives to talk about mutual problems. Until then the parents' experience with the psychiatric services had been most unsatisfactory. The dominant theme in the current meetings was the feeling of relief at finding fellow sufferers. Information about schizophrenia and discussions about expedient patterns of behaviour when in the company of schizophrenic patients were two equally important subjects. The parents showed their approval by very regular attendance of the meetings but stated at the final evaluation that they would like further information and behaviour training. The professional received a first-hand impression of the burden the schizophrenic families have felt obliged to carry and the lack of professional support they have experienced. We believe that the supervision, the education, and the behaviour training of the family can be improved with the current decentralisation of psychiatric services.     

Health care: for patients or for profits?

The author contends that the medical-industrial complex has come to dominate a substantial and growing segment of the health care "market." This complex is characterized by its ability to charge and collect for services, pass through its capital costs, and skim off profitable patients--and, at the same time, to shun its proportionate responsibility for the medically indigent, for the costs of medical education and research, and for meeting community needs. He concludes that physicians have an ethical imperative to join in a broad public coalition to protect equity and quality in medical care.     

Cognitive behavior therapy for depression? Choose horses for courses

OBJECTIVE: Although cognitive behavior therapy is a widely accepted treatment for depression, the problematic nature of efficacy studies is insufficiently recognized. METHOD: The authors reviewed original studies and quantitative analyses on the use of cognitive behavior therapy for depression. RESULTS: The authors suggested that claims for cognitive behavior therapy's efficacy on depression have been overstated, questioned whether its efficacy fits within its theoretical underpinning, and argued against viewing cognitive behavior therapy as a universal rather than a targeted strategy. CONCLUSIONS: Although cognitive behavior therapy may act more by its nonspecific therapeutic ingredients, the authors argued that by testing cognitive behavior therapy's efficacy in heterogeneous study groups, rather than in specific subgroups, failure to differentiate it from control therapies may have been ensured.     

Screening for neuropsychological deficits--a screening test also for dementias?

To assess further the psychometric features of neuropsychological deficit screening (NDS), three groups of patients (41 demented, 23 not demented but cognitively impaired, and 50 controls) were examined and the results compared with two older tests, the Mattis dementia rating scale (MDRS) and the mini mental status test (MMST). As a result, the discriminating ability of NDS (modified for this study) was comparable to both other tests without surpassing them in either demented or cognitively impaired groups. An abbreviated version allowed for an improvement in economy without sacrificing discriminating properties. The advantage of NDS thus lies in the diversity of functions assessed, while its screening power is comparable to the two other tests used for comparison.     

Instructions for Review Articles

The systemic, detailed and clear searching methods should be applied for the related articles by the authors. Abstract: Title: Same as instructions for original articles Abstract: Six-segment structured abstract both in Chinese and In English OBJECTIVE: …     

Genes for Schizophrenia and Bipolar Disorder? Implications for Psychiatric Nosology

It has been conventional for psychiatric research, including the search for predisposing genes, to proceed under the assumption that schizophrenia and bipolar disorder are separate disease entities with different underlying etiologies. These represent Emil Kraepelin's traditional dichotomous classification of the so-called "functional" psychoses and form the basis of modern diagnostic practice. However, findings emerging from many fields of psychiatric research do not fit well with this model. In particular, the pattern of findings emerging from genetic studies shows increasing evidence for an overlap in genetic susceptibility across the traditional classification categories-including association findings at DAOA(G72), DTNBP1 (dysbindin), COMT, BDNF, DISC1, and NRG1. The emerging evidence suggests the possibility of relatively specific relationships between genotype and psychopathology. For example, DISC1 and NRG1 may confer susceptibility to a form of illness with mixed features of schizophrenia and mania. The elucidation of genotype-phenotype relationships is at an early stage, but current findings highlight the need to consider alternative approaches to classification and conceptualization for psychiatric research rather than continuing to rely heavily on the traditional Kraepelinian dichotomy. As psychosis susceptibility genes are identified and characterized over the next few years, this will have a major impact on our understanding of disease pathophysiology and will lead to changes in classification and the clinical practice of psychiatry.     

Epilepsies and neuronal plasticity: for better or for worse?

Extensive experimental investigations have confirmed that "seizures beget seizures." Thus, in adults, limbic seizures lead to cell loss, followed by the formation of novel excitatory synapses that contribute to generating further seizures. The triggering signal is an enhancement of synaptic efficacy, followed by a molecular cascade that triggers axonal sprouting. New synapses are aberrant, since they are formed in regions in which they are not present in controls. They also involve receptors that are not present in controls, and this facilitates the generation of seizures. Therefore, an aberrant form of reactive neuronal plasticity provides a substrate for the long-lasting sequelae of seizures. Since these events take place in brain structures involved in integrative and mnemonic functions, they will have an important impact. Reactive plasticity is documented for other insults and disorders, and may be the basis for the long-term progression of neurodegenerative disorders.     

Developing an evidence‐base for accessibility for people with aphasia

Background: Discrimination on the basis of disability is prohibited in many countries and therefore research on communication accessibility for people with aphasia has become a priority.

Aims: The aim of this paper is to summarise and discuss the results of a series of research studies, carried out in one Centre, into accessibility issues for people with aphasia, focusing on the accessibility of community environments and the accessibility of information.

Main Contribution: When asked about the accessibility of the community generally, people with aphasia reported both physical and societal barriers and facilitators, as well as barriers and facilitators related to other people. Many people with aphasia still do not receive written health information about aphasia and, when they do, the information is often written at a level too high for them to read. In terms of the accessibility of written information on websites about aphasia, high‐quality websites may not be easily accessible to people with aphasia. For accessible websites to be delivered, the involvement of people with aphasia is paramount.

Conclusions: There are three common themes emerging from this series of research studies. First, accessibility is an important and often emotive issue for people with aphasia. Second, people with aphasia are marginalised by a communicatively inaccessible society. Third, there is considerable diversity among people with aphasia about their perceptions of the barriers and facilitators to communication in the community.     

Common networks for selective auditory attention for sounds and words? An fMRI study with implications for attention rehabilitation

Purpose: In an fMRI study the functional networks involved in auditory selective attention for sounds and words were investigated. Methods: 24 healthy volunteers (12 male, 12 female) had to respond to a category of targets (animal sounds vs. musical instruments, spoken names of instruments vs. animals; 6 targets, 12 nontargets) presented via headphones. Results: Under both the sound and word condition besides left superior and middle temporal lobe activation there was bilateral activity in the superior frontal (including the anterior cingulate cortex ACC), middle and inferior frontal and inferior parietal lobes. Under both conditions we also found cerebellar activity. In general there was a high overlap of the related attention networks for both conditions. Conclusions: The activation patterns revealed a high overlap across stimulus conditions with only slight modulation caused by the quality of the auditory material. For rehabilitation of attention deficits after brain damage this implicates that a single training procedure might address a common network for selective attention deficits under different stimulus conditions.     

Evidence for the effectiveness of botulinum toxin for writer’s cramp

Summary We performed a comprehensive literature search of clinical studies published between 1989 and 2007 concerning the use of botulinum neurotoxin (BoNT) in the treatment of writer’s cramp (WC). Publications were categorized as Classes I–IV using the scale developed by the Therapeutics and Technology Assessment (TTA) subcommittee of the American Academy of Neurology. Our search resulted in 17 clinical publications discussing the treatment of WC with BoNT. The literature search results were: one publication being Class I, two being Class II, 11 being Class III, and three being Class IV. Correspondence: Khashayar Dashtipour, Department of Neurology, Loma Linda University, Faculty Medical Offices, 11370 Anderson Street, Suite 240, Loma Linda, CA 92354, USA