Evidence for Interventions for Young Offenders

Young offenders are an issue of global concern. Despite a greater understanding of the aetiology of conduct disorder and juvenile delinquency, the research on treatments and the use of evidence-based methods of interventions has not kept pace. This review critically and selectively examined interventions for young offenders, and organises them based on levels of care. The challenge is to intervene using empirical strategies that are implemented based on our emerging understanding of aggression.     

Lower threshold for referral for psychiatric treatment for adopted adolescents.

Epidemiological data on a national sample of 3,698 adolescents, of whom 145 were adopted, indicate that adoption significantly increases the likelihood of referral for psychiatric treatment even after controlling for the fact that adoptees display more behavior problems and come from more educated families. This is accounted for by the fact that adoptees are significantly more likely to be referred when they display few problems. Thus, contrary to popular myth and clinical lore, the overrepresentation of young adoptees in clinical settings is not attributable solely to the fact that adoptees are more troubled. Rather, adoptees do display more problems but they are also referred more readily even after controlling for extent of problems.     

The need for regulatable vectors for gene therapy for Parkinson's disease

Gene therapy is now a very promising approach for the treatment of Parkinson's disease, for which there are currently few treatment options. However, gene therapy is invasive and irreversible, and its long-term effects are not yet known. Regulatable vectors allow the expression of the introduced gene to be adjusted or stopped by changing the dose of an oral inducer drug, thus adding an important safety mechanism as well as the ability to tailor the dose to an individual patient's needs. Although the use of conventional gene therapy should not be delayed until regulatable systems are available, clinical trials of regulatable gene therapies are imminent. Regulatable systems provide the best hope for safely delivering effective, flexible treatments over the long course of Parkinson's disease, and their development should be actively supported.     

Growing Evidence for Psychodynamic Therapy for Depression

Psychodynamic therapy (PT) for depression is the least examined treatment method for depression, compared to cognitive-behavioral therapy (CBT) and interpersonal therapy. This article, consisting of five randomized clinical trials of short psychodynamic supportive psychotherapy (SPSP) conducted over the last 25 years in Amsterdam, will review the trial results to provide answers to the question about which role SPSP can play in the treatment of depression. The researchers conclude that it is justified to qualify SPSP an empirically supported therapy form of PT for depression. In particular, adding SPSP to pharmacotherapy yields better results than pharmacotherapy by itself. Adding medication to SPSP may have a significant added value, but it is not as large as in the first comparison. The results also confirm no difference in efficacy between CBT and SPSP.     

A scale for rating suitability for insight-oriented psychotherapy

ABSTRACT– An instrument for rating patients as suitable (I) or not suitable (NI) for insight-oriented psychotherapy, is described. It is based on factors suggested by Dewald, and consists of 24 scales, each with 5 steps. Inter-rater reliability was > 0.60 in 11 of the scales in a study of 25 cases, and four subscales were significantly correlated to suitability for insight-oriented psychotherapy according to the total scale: “influence of environmental factors on the symptoms”, “variability of the symptoms during the last year”, “self-confidence”, and “possibility of psychodynamic formulation with a circumscribed focus”. Construct validity was estimated by comparing 29 pairs of I and NI patients. I patients belonged to a higher social class, scored higher on the personality trait dominance and lower on neuroticism, had a more positive experience of the therapist, had lower symptom intensities, and were given a lower global rating of the disorder. I patients were more improved than NI patients when given unspecific treatments. The differences were, however, small. Predictive validity in 38 patients was low which may be due to the fact that the rater had to consider the research points of view, the global nature of several variables and the coarse criteria for correct allocation.     

A decision-making model for pre-sentence evaluations for juveniles

Forensic mental health assessments (FMHAs) are requested by the courts to assist in the sentencing process and can have a major impact upon the life of the person evaluated. Completing these assessments is a core competency for forensic psychologists. However, some FMHAs are undertaken by psychologists who have no forensic training. Despite this, there are no formalised Australian minimum standards to ensure reports are helpful to the courts and reflect sound evaluation methodologies. Drawing upon a critical review of the literature and recent research findings, we propose a 10-step decision-making model for pre-sentence evaluations of juveniles. Our model provides a framework for decision-making and highlights the key elements of an evaluation. The model provides a basis for developing practice guidelines and professional standards. The next step is to test the model in the field to determine its impact on the quality of psychological pre-sentence reports.     

Challenges for gene therapy for muscular dystrophy

Gene therapy for muscular dystrophy represents a promising avenue of pursuit for a disease with a limited repertoire of treatment. Recent successes in the research arena using adeno-associated viral vectors should accelerate the movement of gene-based therapeutics for muscle disorders into the clinic. Nevertheless, significant challenges remain before gene therapy can deliver on the promises avowed by early pioneers of the field. This review examines recent progress and the hurdles remaining to achieve gene-based treatment therapies for muscular dystrophy.     

Challenges for gene therapy for muscular dystrophy

Gene therapy for muscular dystrophy represents a promising avenue of pursuit for a disease with a limited repertoire of treatment. Recent successes in the research arena using adeno-associated viral vectors should accelerate the movement of gene-based therapeutics for muscle disorders into the clinic. Nevertheless, significant challenges remain before gene therapy can deliver on the promises avowed by early pioneers of the field. This review examines recent progress and the hurdles remaining to achieve gene-based treatment therapies for muscular dystrophy.     

The Scope for Psychosocial Treatments for Psychosis

The recent Australian Study on Low Prevalence Disorders (Jablensky et al., 2000) found that, whilst most Australians with a psychotic illness (91%) were taking medication, few were receiving adequate psychosocial support from mental health services; fully 47% of the sample perceived the need for a particular type of service which was not able to be accessed by them, either because of it simply not being available or not being affordable (65% and 49%, respectively, of respondents identified these as barriers). This article outlines a proposed framework that will help meet some of this deficit. The program will develop, evaluate and disseminate comprehensive modular treatment packages addressing the psychosocial needs of people with psychotic disorders. It is novel in terms of the comprehensiveness of the approach, the rigour of the evaluation (using controlled experimental design), and the extent of inter-sectoral and multidisciplinary involvement in mapping needs, developing the interventions, and dissemination.     

Technique for stereotactic body radiotherapy for spinal metastases

Stereotactic body radiotherapy (SBRT) is an emerging technique for spinal tumours that is a natural succession to brain radiosurgery. The spine is an ideal site for SBRT due to its relative immobility and the potential clinical benefits of high dose delivery, particularly to optimise local control and avoid disease progression that can result in spinal cord compression. However, the proximity of the tumour to the spinal cord, with the potential for radiation myelopathy if the dose is delivered inaccurately or if the spinal cord dose limit is set too high, demands technical accuracy with radiation myelopathy a feared complication. Spine SBRT has been delivered with either a robotic-based linac system such as the Cyberknife, or with linac-based systems equipped with a multileaf collimator and image guidance system. Regardless of the technology, spine SBRT demands sophisticated treatment planning and delivery. This case-based technical review outlines the SBRT apparatus, planning and treatment delivery in use at the University of Toronto, Toronto, Canada.     

Genome scan for susceptibility loci for schizophrenia

OBJECTIVE: Schizophrenia is a relatively common, often chronic and debilitating mental illness. Evidence from various studies has clearly demonstrated that genetic factors contribute substantially to the etiology. The goal of this study was to identify chromosomal regions likely to contain schizophrenia susceptibility genes. METHODS: A genome-wide map of 388 microsatellite DNA markers was genotyped in 5 schizophrenia families. Nonparametric linkage analysis (Genehunter) was used to assess the pattern of allele sharing at each marker locus relative to the presence of disease. RESULTS: Nonparametric linkage scores did not reach a genome-wide level of statistical significance (p < 0.00002) or a p value suggestive of linkage (p < 0.007) for any marker; however, one p value suggested replicated linkage (p < 0.01) at chromosome 6p24 in region D6S309 (p = 0.0047). Furthermore, 11 markers resulted in p < 0.05 at chromosomes 6p, 6q, 10q, 12q and 14q. CONCLUSIONS: Despite the differences in diagnostic schemes, in markers used and methods of analyses between studies published so far, we think that our result supports the notion that there is possibly some consistent evidence for replicated linkage of a schizophrenia susceptibility locus around the region of D6S309 at chromosome 6p24.     

Need for palliative care for neurological diseases

The new concept of palliative care supports the idea of palliation as an early approach to patients affected by disabling and life-limiting disease which focuses on the patient’s quality of life along the entire course of disease. This model moves beyond the traditional concept of palliation as an approach restricted to the final stage of disease and widens the fields of intervention. There is a growing awareness of the importance of palliative care not only in oncological diseases but also in many other branches of medicine, and it appears particularly evident in the approach to many of the most frequent neurological diseases that are chronic, incurable and autonomy-impairing illnesses. The definition and implementation of palliative goals and procedures in neurology must take into account the specific features of these conditions in terms of the complexity and variability of symptoms, clinical course, disability and prognosis. The realization of an effective palliative approach to neurological diseases requires specific skills and expertise to adapt the concept of palliation to the peculiarities of these diseases; this approach should be realized through the cooperation of different services and the action of a multidisciplinary team in which the neurologist should play a central role to identify and face the patient’s needs. In this view, it is paramount for the neurologist to be trained in these issues to promote the integration of palliative care in the care of neurological patients.