Anorexia nervosa. Psychoneurotic characteristics of parents: relationship to prognosis. A quantitative study

Using a standardised measure, the psychoneurotic characteristics of the parents of a consecutive series of female patients with primary anorexia nervosa have been examined in relation to those of a ‘normal’ population comaparable in age, sex and marital status. They have also been examined in relation to the treatment and six-month outcome of the illness in their daughters. Treatment initially involved restoration of weight back to matched population mean levels. Following such treatment the majority of parents became more ‘psychoneurotically’ disturbed and this was particularly so if the marital relationship was poor or the patient's pattern of illness included habitual overeating and vomiting. Six-month outcome for the patient's illness was importantly related to the initial levels of ‘psychoneurotic’ morbidity in the parents. The findings are briefly discussed.     

Reported incidence and treatment modalities of giant cerebral aneurysms in the pediatric population: A systematic review and illustrative case report

Giant intracranial aneurysms represent a complex pathology that pose challenges for management, especially in the pediatric population. With emerging endovascular techniques, combined endovascular and open surgical approaches may be a favorable alternative for complex cases. In this systematic review, we characterize the treatment modalities of giant aneurysms in the pediatric population and provide an update on the number of giant aneurysms reported in the literature by anatomic location. We conducted a literature search of PubMed, Embase, and Medline databases with the following terms: ‘pediatric’ AND ‘giant’ AND ‘intracranial aneurysm.’ Studies were included if data on treatment modality and aneurysm location were available for pediatric patients with giant intracranial aneurysms. The literature search yielded a total of 188 papers, with 82 pediatric patients from 33 articles ultimately meeting inclusion criteria. There were significantly more male than female patients (p = 0.011), with 52 and 29 respectively. Patients presenting with a ruptured aneurysm were significantly younger than patients presenting without rupture (p = 0.018), with a median age of 8.0 and 12.0 years, respectively. There were 45 giant aneurysms reported in the anterior circulation and 37 in the posterior circulation. Anterior aneurysms were most often treated with surgical approaches, while posterior aneurysms were typically treated with endovascular interventions (p = 0.002). Although combined surgical and endovascular approaches were the least frequently utilized, we suggest a combined approach may be particularly useful for patients with complex cases that require a management plan tailored to their needs.     

Holding the patient to account at the gatekeeping stage

Underlying the arguments against hospitalisation of some mentally disordered offenders, and violent offenders in particular, is the fear that such people are ‘getting away with it’ or that the psychiatrists have been ‘duped’ . There may be some justification for these concerns in that health service staff often have a very muddled approach to concepts of responsibility among their patients. This in turn can confuse the patients and be counter-therapeutic. Among staff it can foster unduly authoritarian approaches of dubious morality. A proposal is presented for a much more objectively enquiring approach to patient behaviour, with rational, reasoned responses, which may include prosecution under the criminal justice system. Such approaches are not incompatible with hospital treatment, whether as an inpatient or outpatient. While these approaches may be applied to a patient with any mental disorder, including a psychotic illness, they are perhaps of particular importance in relation to those patients with an antisocial personality disorder, for whom limits must be clear and the appropriate establishment of personal responsibility is so important.     

Glia‐related genes and their contribution to schizophrenia

Schizophrenia, a debilitating disease with 1% prevalence in the general population, is characterized by major neuropsychiatric symptoms, including delusions, hallucinations, and deficits in emotional and social behavior. Previous studies have directed their investigations on the mechanism of schizophrenia towards neuronal dysfunction and have defined schizophrenia as a ‘neuron‐centric’ disorder. However, along with the development of genetics and systematic biology approaches in recent years, the crucial role of glial cells in the brain has also been shown to contribute to the etiopathology of schizophrenia. Here, we summarize comprehensive data that support the involvement of glial cells (including oligodendrocytes, astrocytes, and microglial cells) in schizophrenia and list several acknowledged glia‐related genes or molecules associated with schizophrenia. Instead of purely an abnormality of neurons in schizophrenia, an additional ‘glial perspective’ provides us a novel and promising insight into the causal mechanisms and treatment for this disease.     

Experience of child and adolescent mental health clinicians working within an at-risk mental state for psychosis service: a qualitative study

Aim: To qualitatively examine the common experiences of child and adolescent mental health clinicians working with adolescents suspected of having an ‘at‐risk mental state’ (ARMS) for psychosis. Methods: A semistructured interview was conducted with six experienced child and adolescent mental health clinicians working in North East England. Results: A thematic analysis of clinicians' experiences indicated that the identification and management of an ARMS within this patient group is particularly complex. In terms of treatment options, approaches that promoted social inclusion were favoured, but the use of antipsychotic medication was perceived as a ‘last resort’, requiring serious consideration. Clear guidelines and an overall consensus were judged to be lacking in terms of coordinating care and multi‐agency working practices. Conclusions: Establishing a formalized care pathway that also incorporates regular training and supervision may be required by this and other clinical services working with adolescents suspected of having an ARMS. Improved identification, a firmer evidence base regarding treatment practices and clear guidelines are required for this age group. This need will become more urgent should a psychosis risk syndrome be included as a diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐V).     

Estimates of the prevalence of bipolar affective disorder METHODS BASED ON TREATMENT WITH LITHIUM

During this century the epidemiology of the affective disorders has been studied, several classifications have been described and effective treatment measures have been introduced. Difficulties have been encountered in the epidemiology area due to inconsistent use of the terminology of measurement and varying types of classification; although it is possible to arrive at a broad consensus of agreement if the data are examined restrictedly. The clinical need for accurate rates of illness has become greater since the inception of the prophylactic drug lithium carbonate. While not used specifically for bipolar affective disorder, it is only for this disorder that its use has been demonstrated beyond doubt. The occurrence of mania in this disorder enables this aspect of the condition to be used as a marker. This paper describes three measures of the period prevalence of bipolar affective disorder, based upon treatment with lithium, two of which are of the ‘unobtrusive’ type. Agreement was found between the three approaches and the utility of these for general use is discussed.     

Dropping out of psychiatric treatment: a methodological contribution

Mazzotti E, Barbaranelli C. Dropping out of psychiatric treatment: a methodological contribution. Objective: Treatment interruption rate among psychiatric patients varies from 26% to 82%. In order to evaluate the determinants of compliance and dropping out in out‐patient psychiatric clinics, we utilized Ajzen’s theory of planned behaviour. Method: In the pilot stage (n = 164), a questionnaire was administered to elicit the patient’s salient beliefs associated with the intention to contact the service. In the main stage, a new, broader sample (n = 239) was asked to fill in a structured questionnaire including the basic components of the Ajzen’s theory; a structural equation model was used for the evaluation of the fit between the relationships hypothesized by the theory and the empirical data gathered from the sample. Results: The most important predictor of ‘intention’ is ‘perceived behavioural control’, followed by ‘attitude’. It was found that ‘past behaviour’ vs. ‘intentions’ was significant predictor of dropping out. Conclusion: Dropout patients were more likely to have already been in psychiatric treatment and to have had a past history of missed appointments. Our results suggest that knowing previous treatment history and the role of interruptions could equip mental health carers for the rapid retrieval of dropouts, reducing the burden on patients’ families and the risk of patients themselves.     

注意缺陷与多动障碍儿童的家庭动力学研究(英文)

背景 对注意缺陷与多动障碍儿童需要辅于家庭治疗,开展这一辅助治疗就要求详细了解这些家庭的动力学特征。目的 探讨注意缺陷与多动障碍(Attention Deficit Hyperactivity Disorder,ADHD)儿童的家庭动力学特征。方法采用 19 项的系统家庭动力学自评量表(Questionnaire of Systematic Family Dynamics,QSFD)对就诊于南京脑科医院的 46 例ADHD患儿(10～17岁)和 46 名性别、年龄相同的对照学生的家庭动力进行评估。该量表评估家庭功能的4个维度:家庭气氛、个性化、系统逻辑以及疾病观念。结果 两组的疾病观念无明显差异。ADHD组患儿报告家庭氛围不佳,个性化程度低,家庭内更多使用"非此即彼"的绝对化逻辑。父母的受教育程度和家庭经济状况可能影响结果,校正了上述混杂因素的影响后,家庭氛围不佳和个性化程度低在ADHD患儿中仍有统计学意义。患儿自评的QSFD问卷4个维度的内部一致性欠佳(α=0.44～0.53)。结论 该研究初步调查了ADHD患儿的家庭动力学特征,结果显示,患儿报告的家庭气氛更显沉闷,家庭成员间情感和行为的分化程度低。今后需要进一步开展工作,以提高中国家庭动力学评估方法的效度,尤其是将孩子作为信息来源。尽管如此,在传统的药物治疗和行为治疗基础上对ADHD患儿辅以家庭治疗时,本研究的评估方法还是提供了有用的信息。     

Cognitive rehabilitation and cognitive training for mild dementia

Cognitive deficits caused by dementing illnesses are chronic and progressive problems, which should be tackled both by biological and non‐biological approaches. Among the various techniques of non‐biological approaches (cognitive rehabilitation), centered is cognitive training intervention for individuals with dementia. Cognitive training is further divided into two different types of setting: group and individualized. Among group training techniques, the reality orientation training and day care/day services are known to have evidence‐based efficacy. Individually tailored cognitive training aims to directly and explicitly improve cognitive functioning of people with dementia specifically in the early stages. Increasing evidence demonstrates the efficacy of various individualized training programs for dementia, including Alzheimer's disease (AD). Specifically, three techniques, known as spaced retrieval, dual cognitive support and procedural memory training, have shown promise in their ability to enhance learning in people with dementia. In addition, recent studies have suggested that a combination of pharmacotherapy and cognitive training may benefit individuals with AD. Cognitive training appears to be particularly effective for people with mild memory impairment who are on cholinergic treatment. It is now widely accepted that the theoretical framework of ‘errorless learning’ is also a guiding principle in the realm of cognitive training for people with dementia. Although the effect of factors, namely effort (effortful vs effortless) and stimulus features (perceptual vs conceptual), has not been fully determined, error elimination during learning sessions is essential for favorable outcomes.     

Editorial perspective: Treatment of complex maltreatment – beyond the NICE guideline? Manuals,muddles or modules

Providing adequate treatment services for maltreated children is a considerable challenge. The recently updated NICE guideline on Child abuse and neglect (NICE guideline [NG276] 2017, London) includes recommendations on intervention for a variety of parenting contexts, and different forms of maltreatment at various stages of identification: ‘Early Help for families showing possible signs of abuse and neglect’, and ‘Therapeutic interventions for children, young people and families, after child abuse and neglect’. The fifteen evidence‐based manualised approaches to be considered for use by practitioners are valuable and backed up by appropriate research on effectiveness. Approaches are selected which could be applied to more than one form of maltreatment. However, the manualised approaches reviewed by NICE have differing theoretical frameworks and attempting to put together an intervention for more complex forms of maltreatment, based solely on these approaches, may result in confusion and muddle. In practice, polyvictimisation or multipart maltreatment is now seen as the rule, rather than the exception. In these cases, whole sibships may be affected, with children of different ages and stages of development presenting with differing needs. As a result, there is a cumulative, negative impact on their health and development. As Macdonald et al. (Health Technology Assessment, 2016, 20, 1) state, ‘Most children experience more than one form of maltreatment, and there is growing recognition of the need to better take into account children's profiles of maltreatment in order to improve policy and practice’ (p. 38). Marchette and Weisz (Journal of Child Psychology and Psychiatry, 2017, 58, 970) draw attention to the paradox that there are many focal treatment manuals in the child mental health field, which have contributed to practice, but which are not used widely in everyday practice, due to a focus on single disorders rather than the reality of comorbid, co‐occurring problems. Few practitioners or service providers have the time or resources to learn a different approach for each disorder or problem type. A solution is the development of modular approaches. Effective practice elements can be ‘distilled’ from the intervention approaches recommended by NICE and from other evidence‐based interventions identified (Bentovim and Elliott, Journal of Clinical Child and Adolescent Psychology, 2014 43, 270). Practice elements can be integrated into a flexible modular approach to intervention which can be tailored to fit the complex profiles of those maltreated children, young people and their families whom practitioners work within their everyday practice.     

Are in-patient depressives more often of the melancholic subtype?

In contrast to out-patients, hospitalized depressed patients have been reported to respond better to tricyclic antidepressants (TCAs) than to selective serotonin reuptake inhibitors (SSRIs) and moclobemide. This may be due to differences in the type of patients included in the trials. The hypothesis that hospitalized depressed patients have a different symptom profile to out-patients was tested by comparing 352 patients from three in-patient studies with 581 patients from three out-patient studies conducted in Denmark during the period 1980–1992. All patients had major depression and were evaluated using the Hamilton Depression Scale. The full version of the Newcastle Diagnostic Rating Scale (1965) was applied to 443 of the patients. In-patients were characterized by higher scores on the items ‘depressed mood’, ‘suicidal impulses’,‘work and interest (reduced)’, ‘retardation’, ‘distinct quality of depression’, ‘weight loss’, ‘feeling of guilt’ and‘nihilistic delusions’, and by lower scores on the items ‘somatic complaints’, ‘hypochondriasis’, ‘psychological stressors’ and‘anxiety’. In total, 76% of the in-patients and 40% of the out-patients had melancholic/endogenous depression. These findings may explain why TCAs are superior to SSRIs and moclobemide in hospitalized patients, since other data indicate that TCAs seem to be the most effective treatment for the melancholic/endogenous subtype.     

Prevention and early intervention for vascular dementia in community dwelling elderly: Findings from the Nakayama study

Cerebrovascular disease (CVD) may be the single most common risk factor for age‐associated dementia (in particular for vascular dementia (VaD)), and there is definite potential for prevention and treatment of CVD. After one of the most comprehensive and precise type‐specific prevalence surveys of dementia (first Nakayama study), we have continued the preventive and early interventional approaches to CVD and VaD, including treatment of cardiovascular risk factors. In this cohort study, 88% of patients with ‘vascular cognitive impairment without dementia’, who were alive at 3‐years follow up, were still diagnosed with ‘vascular cognitive impairment without dementia’ and only 12% progressed to dementia. Compared with the results of previous studies, active control of risk factors and prevention of recurrent stroke may reduce the incidence of dementia and slow the progression of cognitive impairment in patients with ‘vascular cognitive impairment without dementia’.     

Psychosocial treatment of the geropsychiatric patient

Although clinicians believe strongly in the efficacy of various psychotherapeutic approaches to the geropsychiatric patient, to date there have been relatively few studies to validate these claims. We will selectively review some of the more clinically relevant studies concerning individual psychodynamic, cognitive, and behavioral psychotherapy, focusing on treatment of the depressed geriatric patient. Also reviewed are studies about the cost-effectiveness of psychiatric intervention, as well as innovative hospital-based treatment modalities. Although progress has been made, Rechtschaffen's succinct summary of the psychotherapy literature in 1959 is still pertinent today; ‘As is true for psychotherapy as a whole, systematic, controlled studies of the effectiveness of various treatments of older people are still lacking. Ultimately, there must be empirical grounds for predicting which type of treatment will work best for which type of patient’ (Rechtschaffen, 1959).     

Ethics in Neuroscience Curricula: A Survey of Australia, Canada, Germany, the UK, and the US

This paper analyses ethical training in neuroscience curricula at universities in Australia, Canada, Germany, the United States and the United Kingdom. The main findings are that 52 % of all courses have ethical training available, while in 82 % of those cases, the training is mandatory. In terms of specific contents of the teaching, ethical issues about ‘animal subjects and human participation in research’, ‘scientific misconduct’, and ‘treatment of data’ were the most prominent. A special emphasis during the research was placed on the prevalence of dual-use bioethics. In total, only 3 % of all courses mention it in any of their modules. One of the major findings of the survey was the trend towards ‘mainstreaming’ ethics education particularly in the UK, which is to disperse ethics among the various modules within the education instead of relying on a single ethics module. The paper discusses the utility of this approach for science education as well as describes the overall difficulties that course coordinators face when trying to teach ethics based on the responses to the qualitative part to the survey.     

Cortical dysplasia in surgical pathology of intractable epilepsy

Recent knowledge on cortical malformative lesions, which have been targets for surgical treatment in the control of intractable epilepsy, is covered in this paper. Focal cortical dysplasia of Taylor (1971) has been established as a clinico-pathological entity in which a variety of dysplastic cells are seen, such as cytomegalic neurons, bizarre glial or neuronal cells and ballooned cells of both origins. In a strict sense, ‘cortical dysplasia’ should imply ‘focal cortical dysplasia’ of Taylor, although the term ‘cortical dysplasia’ is occasionally used to cover a wider spectrum of cerebral malformation. Other indications in malformative lesions for surgery are hemimegalencephaly and tuberous sclerosis. Recently, special attention has been given to the coexistence of focal cortical dysplasia and tumors, which include mixed neuroglial tumors such as ganglioglioma or dysembry-oplastic neuroepithelial tumors.     

Dreaming of mathematical neuroscience for half a century

Theoreticians have been enchanted by the secrets of the brain for many years: how and why does it work so well? There has been a long history of searching for its mechanisms. Theoretical or even mathematical scientists have proposed various models of neural networks which has led to the birth of a new field of research. We can think of the ‘pre-historic’ period of Rashevski and Wiener, and then the period of perceptrons which is the beginning of learning machines, neurodynamics approaches, and further connectionist approaches. Now is currently the period of computational neuroscience. I have been working in this field for nearly half a century, and have experienced its repeated rise and fall. Now having reached very old age, I would like to state my own endeavors on establishing mathematical neuroscience for half a century, from a personal, even biased, point of view. It would be my pleasure if my experiences could encourage young researchers to participate in mathematical neuroscience.     

Characteristics of the eating disorder in Prader-Willi syndrome: implications for treatment

Over-eating and resultant obesity is well recognized as a central feature of the Prader–Willi Syndrome (PWS). The eating behaviour of 13 subjects with PWS was been studied retrospectively over a 28-day period and also by direct observation when given free access to food. Changing cognitions normally associated with food intake (e.g. changes in hunger) were assessed using visual analogue scales (VAS) and by asking subjects to rate photographs of particular foods. Eight out of 13 subjects (61 %) with PWS had to have their access to food severely restricted. Ten (77%) ate excessive amounts when given free access to food, and although feelings of ‘hunger',‘desire to eat’ and ‘fullness’ changed in the expected direaion. these changes were delayed, compared to a control group, and only occurred after eating a significantly greater amount of food. Ratings of ‘hunger’ and ‘fullness’ started to return to pre-meal levels sooner than in the controls. The present authors consider that PWS is an example of genetic obesity secondary to an impaired satiety response. These observations have important implications for treatment.     

To Naturalize or Not to Naturalize? An Issue for Cognitive Science as Well as Anthropology

Several of Beller, Bender, and Medin’s (2012) issues are as relevant within cognitive science as between it and anthropology. Knowledge‐rich human mental processes impose hermeneutic tasks, both on subjects and researchers. Psychology's current philosophy of science is ill suited to analyzing these: Its demand for ‘‘stimulus control’’ needs to give way to ‘‘negotiation of mutual interpretation.’’ Cognitive science has ways to address these issues, as does anthropology. An example from my own work is about how defeasible logics are mathematical models of some aspects of simple hermeneutic processes. They explain processing relative to databases of knowledge and belief—that is, content. A specific example is syllogistic reasoning, which raises issues of experimenters’ interpretations of subjects’ reasoning. Science, especially since the advent of understandings of computation, does not have to be reductive. How does this approach transfer onto anthropological topics? Recent cognitive science approaches to anthropological topics have taken a reductive stance in terms of modules. We end with some speculations about a different cognitive approach to, for example, religion.