What do we really know about late-onset schizophrenia?

Actual knowledge on classical late-onset schizophrenia, i.e. the schizophrenic disorders with onset after age 40 years, is reviewed regarding incidence, symptomatology and course. As is shown, sound empirical knowledge is scarce. Reasons for this are, on the one hand, the conceptual and terminological confusion which has occurred internationally regarding this illness group, and, on the other hand, the methodological limitations of the empirical studies conducted on this clinical picture thus far. If we only draw onclassical late-onset schizophrenia, as originally defined by Bleuler, and primarily on methodologically sound studies, as well as on own studies, we can nevertheless conclude that the term “late-onset schizophrenia” could be omitted. Late-onset schizophrenia does not seem to be a distinct entity, but instead seems to belong to the same illness group as classical schizophrenia with earlier onset. Slight differences in symptomatology and course are probably due to unspecific influences of age. The markedly higher proportion of women among late-onset cases, as well as our finding that symptomatology and course of late-onset women are comparably poor, could possibly be explained by an effect of the female sex hormone oestradiol.     

What do we really know about amyotrophic lateral sclerosis?

The cause of amyotrophic lateral sclerosis is unknown. In this review clinical and scientific data that are pertinent to understanding this disease are reviewed. There are currently several major controversies concerning the possible role of immunological factors, genetic factors, environmental toxins, and viral infection in pathogenesis. These concepts must be considered in relation to what is known about the disease in all its aspects, including epidemiological data, information on the classical and molecular pathology of the disease, and on associated involvement of other systems, e.g., the spinocerebellar pathways and frontal dementia. Only when all this information is assimilated can full understanding of the disease and, hopefully, a logical approach to treatment and prevention, be achieved.     

There are things that we know that we know,and there are things that we do not know we do not know: Confidence in decision-making

Metacognition, the ability to think about our own thoughts, is a fundamental component of our mental life and is involved in memory, learning, planning and decision-making. Here we focus on one aspect of metacognition, namely confidence in perceptual decisions. We review the literature in psychophysics, neuropsychology and neuroscience. Although still a very new field, several recent studies suggest there are specific brain circuits devoted to monitoring and reporting confidence, whereas others suggest that confidence information is encoded within decision-making circuits. We provide suggestions, based on interdisciplinary research, to disentangle these disparate results.     

What do we really know about community support programs? Strategies for better monitoring

Studies have shown that community support programs are more effective in treating the chronic mentally ill than traditional forms of aftercare. Yet an analysis of 33 controlled studies of community support programs reveals that almost no systematic empirical knowledge exists about their actual implementation, including the kinds of treatment they deliver, how they can be replicated, or what ingredients account for their success. As a result, dissemination of the community support program model has been slower than expected. Developing effective community support programs requires making a commitment to evaluating programs as they are implemented, identifying program variables to monitor, devising methods for monitoring the variables chosen, and drawing from and building on existing literature about program evaluation. Strategies and models for monitoring implementation of community support programs are described.     

Memory and cognition in preclinical dementia: what we know and what we do not know

This overview focuses on the cognitive transition between normal aging and dementia. Numerous studies indicate that individuals who will go on to develop dementia show cognitive deficits many years before the time at which a clinical diagnosis could be rendered. The degree of preclinical impairment is remarkably similar for tasks assessing episodic memory, executive functioning, and perceptual speed, consistent with the view that multiple brain alterations occur prior to clinical disease onset. Although most research in this area has dealt with Alzheimer disease (AD), several recent reports indicate that the pattern of preclinical impairment is very similar in the second largest dementia disorder, vascular dementia (VaD). This is important because currently the possibility for interventions to postpone disease onset is greater in VaD than in AD. Despite pronounced preclinical cognitive deficits in dementia, the performance distributions between cases and controls are largely overlapping, hampering the ability to identify high-risk individuals. To alleviate this problem, future research should evaluate hybrid models for the prediction of dementia. In such models, multiple indicators of cognitive functioning should be included along with markers from other domains that have been linked to subsequent dementia (such as brain imaging, genetics, and lifestyle variables). To the extent that these categories of variables add unique variance, classification accuracy will increase and the overlap in performance scores between incident cases and controls will decrease, thereby enhancing clinical usefulness. This approach would also facilitate the examination of interactive effects among classes of preclinical markers.     

Quality of life in primary progressive aphasia: What do we know and what can we do next?

Background: A quality of life approach to managing communication and neurodegenerative conditions is increasingly encouraged by professional bodies and healthcare models. Clinical services for primary progressive aphasia (PPA) continue to expand and the research base continues to grow; however, there is little research specifically investigating quality of life in PPA.

Aims: This critical review aimed to determine the available knowledge about quality of life in PPA and gaps in that knowledge, and to consider how PPA researchers might best address those gaps.

Main contribution: Two unpublished single case series studies and one published case study were identified that directly investigated aspects of quality of life in PPA. These suggested that quality of life is heterogenous and determined by a range of factors, supporting a person-centred approach to care. The current literature also includes five accounts of living with PPA authored by individuals with PPA or their carers, discussing factors that influenced these individuals’ quality of life. Seventeen empirical investigations of mood were identified, suggesting that approximately 40% of individuals with PPA develop depression at some point. Finally, several recent studies have noted the importance of promoting quality of life in PPA and/or have utilised quality of life outcome measures; however, most lack a clear conceptualisation of the construct of quality of life, and how this construct is related to the instruments and methods chosen to measure it.

Conclusions: Literature on quality of life in PPA is beginning to emerge, although little is available in indexed databases. More research is needed that better conceptualises the construct of quality of life, critically appraises the way quality of life is assessed in PPA, builds on findings from the current small samples, and involves individuals with PPA in formulating research directions and research tools that will enable discussion about their quality of life.     

Incest: what do we really know about it?

The literature on incest is reviewed. Current knowledge rests on a very insecure scientific basis and has been mainly derived from small, highly selected clinical series. Recently, some important epidemiological studies of general populations have been reported, but the results of prevalence are inconsistent. Overall, however, it appears that incest, when defined in terms of sexual intercourse, occurs in less than 1% of the population, but other forms of intrafamilial sexual activity may affect 10% of females before they are 16 years of age. Some children are more at risk than others. Because information has generally been derived from court or treatment samples, we are unclear about the long-term effects of incest experiences but, overall, the impression is that incest has markedly adverse effects, especially if it is accompanied by violence and threats and is directed, as it usually is, at the young pre-pubescent child.     

The concept of quality of life: what we know and do not know

Background Over the past two decades the concept of quality of life (QOL) has increasingly become a focus for research and application in the fields of education/special education, health care (physical and behavioural), social services (disabilities and ageing), and families. Methods This article summarizes our current understanding of the construct of individual QOL as it pertains to persons with intellectual disabilities (ID). The article's three major sections discuss what we know, what we are beginning to understand, and what we still do not know about the QOL construct. Results We currently know the importance of the QOL construct as a service delivery principle, along with its current use and multidimensional nature. We are beginning to understand the importance of methodological pluralism in the assessment of QOL, the multiple uses of quality indicators, the predictors of assessed QOL, the effects of different data collection strategies, and the etic (universal) and emic (culture‐bound) properties of the construct. We have yet to understand fully the use of QOL‐related outcomes in programme change, how to best evaluate the outcomes of QOL‐related services, and how to use the concept of QOL to impact public and disability reform. Conclusion The article concludes with a brief discussion of future challenges related to demonstrating the concept's social validity and positive impact on the lives of persons with ID.     

Research in child language disorders: what do we know and where are we going?

Advances in understanding the nature of language impairment in children over the past decade have been abundant. In this paper, several recurring hypotheses about the nature of the clinical disorder of language impairment in children and underlying etiologies are explored and the ways in which we are moving forward in our understanding of them are considered. Specifically, in the first part, the recent thinking on the nature of specific language impairment as a clinical concept is examined. Characteristics of the population are reviewed and the search for causation is considered. Literature on the relations between language and cognition and between language and social cognition is probed for contributions to our understanding of developmental disorders of language. Two areas in which we have seen marked progress and which hold promise for development in the coming decade are the focus of the second part of the paper. The focal areas are: computer-assisted language sample analyses and neurophysiological contribution to understanding language impairment in children. Thoughts about future directions for work in the area of developmental disorders of language are offered in conclusion.     

The nature of brain abnormalities in schizophrenia: What do we really know?

The etiopathology of schizophrenia remains unknown in spite of a century of investigations of the brain. Neuro-imaging research has shown involvement of frontal cortex, temporal lobe cortex, and subcortical structures. Enlarged ventricles, reduced volumes of frontal cortex (dorsolateral prefrontal cortex), temporal lobe cortex (superior temporal cortex), and subcortical structures such as hippocampus and amygdala have been consistently reported and imply inadequate functioning of these structures. These brain abnormalities as group differences between patients and matched healthy controls are present at the onset and some even before the onset of psychosis, supporting the neurodevelopmental theory of schizophrenia. Dopamine is still believed to be the major neurotransmitter involved in schizophrenia, although others such as serotonin and glutamate are possibly involved. Schizophrenia is inherited, but genetic research has not yielded a clear answer, possibly due to the complex nature of the genetic involvement. Although a thorough understanding of the brain abnormalities is far from clear, the evidence is constantly accumulating and converging toward a possibly complex illness of a brain network that is affected by a genetically mediated developmental deviance.     

HIV in adolescents: What we know and what we need to know

HIV, the cause of AIDS, has infected more than 65 million people worldwide, including 1 million children. An estimated 39.5 million people are living with HIV. As of 2006, 4.3 million were newly infected, with 2.8 million occurring in sub-Saharan Africa. Rates of infection have risen more than 50% in Eastern Europe and Central Asia. Mother-to-child transmission occurs rarely with antiretroviral treatments in the United States, and congenitally infected children are living to adulthood. HIV is now a “youth-driven disease” worldwide. In the United States, 40% of new HIV infections occur in individuals less than 25 years old, and HIV is the sixth-leading cause of death among adolescents. Young people with HIV/AIDS live with this chronic condition and its associated medical and psychological morbidities while coping with identity and maturation issues. In this paper, we review what we know about HIV and psychiatric disorders among adolescents.