Dialectical Behavior Therapy in the Treatment of Borderline Personality Disorder and Eating Disorders Comorbidity: A Pilot Study in a Naturalistic Setting

Dialectical behavior therapy (DBT) has been shown to be successful in the treatment of borderline personality disorder and eating disorders separately. The present study compares Standard Dialectical Behavior Therapy with a Treatment as Usual Cognitive Behavior Therapy (TAU CBT) for the treatment of borderline personality disorder and eating disorders comorbid features. A total of 118 women diagnosed with borderline personality disorders and eating disorders were assigned to one of two treatment groups in a naturalistic setting (DBT?=?71; TAU CBT?=?47). DBT showed a greater decrease in dysfunctional behaviors used to regulate emotions and related to borderline personality disorder (i.e. substance abuse, impulsive money spending, unprotected sex, etc.), non-suicidal self-injuries, and depressive symptoms, as well as an increase in cognitive reappraisal and global functioning. DBT and TAU CBT showed similar improvements in suicide attempts, dysfunctional eating behaviors (i.e. binge eating, purgative behaviors, and restriction), hospitalizations, negative and positive affect, and expressive suppression. Results of this study support the utility and effectiveness of standard DBT for comorbid borderline personality disorder and eating disorders in naturalistic settings. Replications of this study and randomized controlled trials are needed.     

It’s a marathon not a sprint: the need for long-term monitoring of myocardial dysfunction in COVID-19

The International Journal of Cardiovascular Imaging -     

Delusional misidentification in Parkinson’s disease: report of two cases and a review

Syndromes of delusional misidentification consist of disordered familiarity and have been reported in diverse diagnoses, including Parkinson’s disease. Although the most common delusional misidentification is Capgras syndrome, in which the sufferer believes a familiar person has been replaced by an identical imposter, other forms have been also described. The pathogenesis of delusions of misidentification appears to require dysfunction of or connection to a left cerebral cortical area involved in recognition of familiarity, and also right frontal cortex serving belief evaluation. Two cases of Parkinson’s disease with an unusual delusional misidentification, intermetamorphosis, are presented, along with their improvement with pimavanserin, a novel atypical antipsychotic medication.     

“It’s the Symptom of the Problem,Not the Problem itself”: A Qualitative Exploration of the Role of Pro-anorexia Websites in Users’ Disordered Eating

The growing trend in the use of the Internet and social media as a method of self-managing illness presents a critical opportunity to better understand the role of pro-anorexia (pro-ana) websites for eating disorders. Therefore, 155 pro-ana website messages regarding criticism that the site was responsible for developing anorexia were inductively thematically analysed. The analysis revealed five main themes: eating disorders are mental illnesses and websites do not cause mental illness, pro-ana websites and eating disorders are more than wanting to be thin (with sub-theme residents and visitors), eating disorders develop regardless of pro-ana websites, pro-ana sites do not cause eating disorders but they may trigger or encourage them (with sub-theme the problem is the user, not the site) and pro-ana sites provide support. Pro-ana websites and online communities present clinicians with complex treatment challenges. Collaborative, therapeutic consultations about pro-ana website use may help to establish how and when accessing them may hinder the treatment process.     

“Waiter’s tip” (Erb’s) palsy: a case report and literature review

As primary health care clinicians, chiropractors are increasingly providing the initial assessment of many diverse musculoskeletal conditions. As a consequence, occasionally chiropractors are consulted to assess rare neuromusculoskeletal disorders. A 12-year-old girl was brought in by her mother for a second opinion on the present status of her daughter’s Erb-Duchenne palsy (Erb’s palsy), a diagnosis given at birth. Erb’s palsy is a birth-induced upper brachial plexus injury that, if unresolved, is known to lead to permanent developmental shoulder and elbow articular deformities. These deformities can result in severe restrictions in the proper function of the involved upper limb. The exact pathogenesis is unclear and therefore certain theories are presented. It would appear that early detection of these functional restrictions and the restoration of normal joint function, through active and passive mobilisation during childhood, are an important factor in limiting the extent of these disabilities.     

Neurotoxicity in Russell’s viper (Daboia russelii) envenoming in Sri Lanka: a clinical and neurophysiological study

Context: Russell’s viper is more medically important than any other Asian snake, due to number of envenoming’s and fatalities. Russell’s viper populations in South India and Sri Lanka (Daboia russelii) cause unique neuromuscular paralysis not seen in other Russell’s vipers. Objective: To investigate the time course and severity of neuromuscular dysfunction in definite Russell’s viper bites, including antivenom response. Methodology: We prospectively enrolled all patients (>16 years) presenting with Russell’s viper bites over 14 months. Cases were confirmed by snake identification and/or enzyme immunoassay. All patients had serial neurological examinations and in some, single fibre electromyography (sfEMG) of the orbicularis oculi was performed. Results: 245 definite Russell’s viper bite patients (median age: 41 years; 171 males) presented a median 2.5?h (interquartile range: 1.75–4.0?h) post-bite. All but one had local envenoming and 199 (78%) had systemic envenoming: coagulopathy in 166 (68%), neurotoxicity in 130 (53%), and oliguria in 19 (8%). Neurotoxicity was characterised by ptosis (100%), blurred vision (93%), and ophthalmoplegia (90%) with weak extraocular movements, strabismus, and diplopia. Neurotoxicity developed within 8?h post-bite in all patients. No bulbar, respiratory or limb muscle weakness occurred. Neurotoxicity was associated with bites by larger snakes (p?<?0.0001) and higher peak serum venom concentrations (p?=?0.0025). Antivenom immediately decreased unbound venom in blood. Of 52 patients without neurotoxicity when they received antivenom, 31 developed neurotoxicity. sfEMG in 27 patients with neurotoxicity and 23 without had slightly elevated median jitter on day 1 compared to 29 normal subjects but normalised thereafter. Neurological features resolved in 80% of patients by day 3 with ptosis and weak eye movements resolving last. No clinical or neurophysiological abnormality was detected at 6 weeks or 6 months. Conclusion: Sri Lankan Russell’s viper envenoming causes mild neuromuscular dysfunction with no long-term effects. Indian polyvalent antivenom effectively binds free venom in blood but does not reverse neurotoxicity.     

Celery root extract as an inducer of mania induction in a patient on venlafaxine and St John’s Wort

Celery root belongs to a group of plants classified as the umbelliferous family, which contains phytoestrogens. Phytoestrogens are structurally similar to estrogen as they share a pair of hydroxyl groups and phenolic ring, which enables them to bind to estrogen receptors directly, making them a herbal remedy for low estrogen states such as menopause. We present a case of a female patient with depression who was stabilized on venlafaxine and St John’s Wort, and who developed a manic episode due to elevated serum venlafaxine levels after she started taking celery extracts for menopausal related issues. We proffer a hypothesis for this unusual occurrence.     

Everyday functioning of people with Parkinson’s disease and impairments in executive function: a qualitative investigation

Purpose: Executive function is the key area of cognitive impairment in Parkinson’s disease. This study investigated how cognitive difficulties impact on everyday life of people with Parkinson’s disease and their carers, and whether they explicitly mention executive-type difficulties.

Methods: Semistructured interviews with 11 people with Parkinson’s disease and six carers were analyzed thematically. People with Parkinson’s disease performed within the normal range on cognitive screening tests, but all had abnormal scores on tests of executive function.

Results: Despite relatively mild executive deficits and no global cognitive impairment, participants described executive-type difficulties as well as a range of problems in other cognitive domains, such as memory, processing speed and apathy. Cognitive difficulties had a far-reaching impact on everyday life and their significance depended on personal circumstances, such as the level of responsibilities of the person with Parkinson’s disease and the extent of available support.

Conclusions: By presenting subjective accounts of living with Parkinson’s disease and cognitive difficulties, this study improves our understanding of how the observed level of cognitive impairment translates into everyday functioning. The study results have implications for recognizing cognitive difficulties and for planning support for people with Parkinson’s disease and their families, and can help identify ways of promoting effective self-management.

• Implications for rehabilitation

• Treatment of Parkinson’s disease tends to focus on the movement disorder, meaning that cognitive difficulties and their impact can be overlooked.

• Participants in this study had only relatively mild executive deficits but described a range of cognitive problems, including executive-type difficulties.

• Cognitive difficulties have an emotional impact and can cause a range of challenges in everyday life, adding to the burden of physical symptoms of Parkinson’s disease.

• Results of this study provide insights into how executive functions impairments translate into everyday difficulties in Parkinson’s disease and have implications for planning support for people with Parkinson’s disease and their families.

     

Oral and dental late effects in survivors of childhood cancer: a Children’s Oncology Group report

Purpose

Multi-modality therapy has resulted in improved survival for childhood malignancies. The Children’s Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers provide practitioners with exposure- and risk-based recommendations for the surveillance and management of asymptomatic survivors who are at least 2 years from completion of therapy. This review outlines the pathophysiology and risks for oral and dental late effects in pediatric cancer survivors and the rationale for oral and dental screening recommended by the Children’s Oncology Group.

Methods

An English literature search for oral and dental complications of childhood cancer treatment was undertaken via MEDLINE and encompassed January 1975 to January 2013. Proposed guideline content based on the literature review was approved by a multi-disciplinary panel of survivorship experts and scored according to a modified version of the National Comprehensive Cancer Network “Categories of Consensus” system.

Results

The Children’s Oncology Group oral-dental panel selected 85 relevant citations. Childhood cancer therapy may impact tooth development, salivary function, craniofacial development, and temporomandibular joint function placing some childhood cancer survivors at an increased risk for poor oral and dental health. Additionally, head and neck radiation and hematopoietic stem cell transplantation increase the risk of subsequent malignant neoplasms in the oral cavity. Survivors require routine dental care to evaluate for potential side effects and initiate early treatment.

Conclusions

Certain childhood cancer survivors are at an increased risk for poor oral and dental health. Early identification of oral and dental morbidity and early interventions can optimize health and quality of life.     

Successfully performing a university student’s role despite disabilities: challenges of an inclusive environment and appropriate task modification

Purpose: To reflect on what it means to successfully perform a university student’s role despite the presence of impairments. Method: The Disability Creation Process (DCP) model is used as a tool to zoom in the different activities and tasks required for a successful education as well as to describe how the social and physical environment can be as inclusive as possible to compensate for different impairments. One activity in the student’s role (reading) is used to illustrate and reflect on potential challenges in compensating for impairments by way of environmental or task modifications. Results: The student’s role is a complex one, characterized by different actions such as getting admitted, moving around, attending courses, studying and participating in student life. Environmental factors or time can facilitate or impede the level of participation in the education domain. One challenge may be to differentiate between compensation for learning (processes) as compared to outcomes (competency level for future employment) as well as to determine how much assistance is acceptable. Conclusion: Intuitive single-case analysis should be replaced by a systematic analysis relying on a conceptual model such as the DCP. To avoid discrimination and to ensure transparency, acceptable amount of compensation for an activity should be defined.

Implications for Rehabilitation

• Providing adequate accommodation to university students’ presenting invisible impairments is a complex issue.

• Intuitive single-case analysis should be replaced by a systematic analysis relying on a conceptual model.

• A clear differentiation between compensation for learning as compared to outcomes (competency level) should be made.

• The acceptable amount of compensation for an activity should be defined to ensure transparency and avoid discrimination.

     

Successful treatment of thromboangiitis obliterans (Buerger’s disease) with immunoadsorption: results of a pilot study

Background  

No established therapy is available for patients with thromboangiitis obliterans (TAO) and critical limb ischemia. Since abnormalities of the immune system appear to be involved in the pathogenesis, we investigated in this pilot study the efficiency of Ig immunoadsorption (IA) therapy.     

WOMAC-pf as a measure of physical function in patients with Parkinson’s disease and late-onset sequels of poliomyelitis: unidimensionality and item behaviour

Purpose: To assess psychometric properties of the Western Ontario and MacMasters Universities Osteoarthritis Index (WOMAC)-pf, an osteoarthritis (OA)-specific questionnaire used to establish the level of physical functioning in patients with late-onset sequels of poliomyelitis (LOSP) and Parkinson’s disease (PD). Study design and setting: Unidimensionality (using principal component analyses [PCA] and Rasch analyses) was separately established for three diagnostic groups: OA (n = 288), LOSP (n = 168) and PD (n = 200). Additionally, differential item functioning (DIF) among the three diagnostic groups was assessed using ordinal regression (Polytomous Universal Model) analyses. Baseline data were used from an ongoing cohort study of these three patient populations. Results: Unidimensionality was adequate, with all items loading on the first principal component. The Rasch analyses revealed that item fit was generally good. Uniform and non-uniform DIF were found to be present among the three diagnostic groups in three and one of the 17 physical functioning subscale (WOMAC-pf) items, respectively. Conclusion: The WOMAC-pf is a unidimensional measure of physical functioning in patients with LOSP and PD, in addition to its established use in OA.

Implications for Rehabilitation

• Disability in physical functioning related to mobility (walking, stair climbing, etc.) is a common feature of many chronic diseases, including osteoarthritis, late-onset sequels of poliomyelitis and Parkinson’s disease.

• In this study, the Western Ontario and MacMasters Universities Osteoarthritis Index-pf was shown to be a useful and adequate tool to assess physical functioning in these patient groups.

• The study highlighted that, despite differences in diagnosis, history and course of the disease, patients with different conditions experience similar disabilities in their physical functioning.

     

Measuring Negative and Positive Thoughts in Children: An Adaptation of the Children’s Automatic Thoughts Scale (CATS)

The aim of this study is to describe the factor structure and psychometric properties of an extended version of the Children’s Automatic Thoughts Scale (CATS), the CATS-Negative/Positive (CATS-N/P). The CATS was originally designed to assess negative self-statements in children and adolescents. However, positive thoughts also play a major role in childhood disorders such as anxiety and depression. Therefore, positive self-statements were added to the CATS. The CATS-N/P was administered to a community sample of 554 children aged 8–18 years. The results of a confirmatory factor analysis revealed that the positive self-statements formed a separate and psychometrically sound factor. Internal and short-term test–retest reliability was good. Boys reported more hostile and positive thoughts than girls; and younger children reported more negative thoughts concerning physical threat, social threat, and failure than older children. In conclusion, the results of the current study support the use of the CATS-N/P for the measurement of positive and negative thoughts in children. The application of the CATS-N/P can facilitate further research on cognitive factors in different childhood disorders.     

Nurse practitioner (NP) led care: Cervical screening practices and experiences of women attending a women’s health centre

Background

Cervical cancer is the second most prevalent carcinoma among women. Stringent screening is the most effective strategy of reducing the morbidity and mortality associated with cervical cancer, however barriers to such screening exist. South West Sydney is primarily populated by ethnic minority groups and those with lower socioeconomic status. Thus, women from this area of Sydney represent some of the most disadvantaged women and face many barriers when accessing healthcare, including cervical cancer screening. Previous research has found that gender can influence attitudes and practices regarding women’s health screening. While women’s health nurse practitioners are becoming more involved in preventative healthcare including cervical cancer screening, the experiences of women who access their services have not been explored.