The three vectors of consciousness and their disturbances after brain injury

Based on the recent review of Zeman (2001) three “vectors” of consciousness aredescribed. A model for understanding how they are related is outlined. Recentbehavioural and neuroimaging studies are reviewed pertinent to this conceptualisation. Initial ideas for working with these disturbances in consciousness during neuropsychological rehabilitation are presented.     

Violence among comorbid and noncomorbid severely mentally ill adults: A pilot study

This pilot study examined the relationship between substance dependence and violence in a sample of severely mentally ill adults. Subjects were 42 psychiatric outpatients enrolled in a clinical case management program in San Francisco, California. Almost 40% of the participants reported perpetrating at least one violent act in the past 12 months. Comorbid participants were over 4% times more likely to commit a violent act in the past 12 months than noncomorbid participants. Substance dependence was also more frequently associated with perpetration of a violent act by female than by male participants and by Caucasian than by African American participants. Comorbid mentally ill participants appear more likely to perpetrate violent acts than those with mental illness alone. The dangers of substance dependence in terms of the perpetration of violence may not be in mental illness or substance dependence alone but in their co‐occurrence. Further investigation is needed to assess risk factors for violence and victimization in multiple environmental and situational domains. It will be important to explore the moderating effects of gender and race on the co‐occurrence of mental illness, substance dependence, and the perpetration of violent acts.     

Patients' understanding of medical terminology used in the breast clinic

This study evaluated patients' understanding of common terms used by breast surgeons in order to identify words which may need to be defined and explained during a clinic consultation. 95 patients completed the survey. 87% defined 'Surgeon' correctly whereas 'Radiographer' and 'Radiologist' were correctly defined by only 19% and 28% respectively. 26% correctly defined 'Pathologist' and 43% 'Oncologist'. Two-thirds of patients correctly defined 'Benign' (66%) and 'Malignant' (65%). 'Mammogram' and 'Ultrasound' were correctly defined by 39% and 8% respectively. 21% of patients correctly defined 'Multi-Disciplinary Team Meeting'. 1 in 5 patients correctly defined 'Chemotherapy' (20%) and 'Radiotherapy' (19%). This study has identified that many of the medical terms used in a consultation are not understood by patients. Education must be incorporated as a routine part of the consultation to enhance the patient experience and ensure they can actively participate in making informed decisions about their care.     

Identification and Management of Malignant Skin Lesions Among Older Adults

The incidence of malignant skin lesions is increasing among older adults. The elderly generally present with different symptoms than younger adults, and lesions tend to have a poorer prognosis. Benign skin lesions, such as senile lentigo and seborrheic keratosis, may confound the identification of malignancy. This article reviews the risk factors and age-related changes that affect the development of skin lesions. After differentiating actinic keratosis, basal cell and squamous cell carcinoma, and malignant melanoma, it discusses nonsurgical, topical, and surgical management options as appropriate for older adults with comorbidities.     

CHRNB3 is more strongly associated with Fagerström Test for Cigarette Dependence-based nicotine dependence than cigarettes per day: phenotype definition changes genome-wide association studies results

AIMS: Nicotine dependence is a highly heritable disorder associated with severe medical morbidity and mortality. Recent meta-analyses have found novel genetic loci associated with cigarettes per day (CPD), a proxy for nicotine dependence. The aim of this paper is to evaluate the importance of phenotype definition (i.e. CPD versus Fagerstr?m Test for Cigarette Dependence (FTCD) score as a measure of nicotine dependence) on genome-wide association studies of nicotine dependence. DESIGN: Genome-wide association study. SETTING: Community sample. PARTICIPANTS: A total of 3365 subjects who had smoked at least one cigarette were selected from the Study of Addiction: Genetics and Environment (SAGE). Of the participants, 2267 were European Americans, 999 were African Americans. MEASUREMENTS: Nicotine dependence defined by FTCD score ≥4, CPD. FINDINGS: The genetic locus most strongly associated with nicotine dependence was rs1451240 on chromosome 8 in the region of CHRNB3 [odds ratio (OR)?=?0.65, P?=?2.4?×?10(-8) ]. This association was further strengthened in a meta-analysis with a previously published data set (combined P?=?6.7?×?10(-16) , total n?=?4200). When CPD was used as an alternate phenotype, the association no longer reached genome-wide significance (β?=?-0.08, P?=?0.0004). CONCLUSIONS: Daily cigarette consumption and the Fagerstrom Test for Cigarette Dependence show different associations with polymorphisms in genetic loci.